In need of some guidance & advice for my poor girl

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Mrs.GusGus

Mrs.GusGus

Member Since 2014
Hi Everyone,

I made a few posts back in April regarding my foster cat, Annie. Life and time got in the way and I was unable to continuously post updates or follow through with everyone's advice.

Now I am feeling desperate. Since the foster organization funds her veterinary costs, I am limited to just one vet clinic/one veterinarian and I feel like I need a second opinion because I am at a loss right now

Brief reminder on Annie:
- Approx. 13 years old
- Diagnosed with diabetes 2-3 years ago
- For a 6 month period was overdosed on her Glargine by 10x (instead of 2u, she was receiving 20u by previous foster home)
- Suffers from brain damage from the prolonged hypoglycemia, resulting in the occasional seizure
- Takes 2 small doses of Phenobarbital every day to control these seizures
- Uncontrollable BG (reaching extreme values), constant peeing outside her litter-box, excessive thirst
- Visible symptoms of neuropathy in her hind & front legs
- Her fructosamine tests reflect an upward trend since April, her most recent fructosamine test read 489 (July 2014)

I have attached some values over the last month, these numbers are very similar to what I have been seeing for the last 4-5 months... little to no improvement over this time. Here are the protocols I have been following for the last little while:

-April to August 1st: She was receiving 2.0u of Glargine ONLY when her BG≥216mg/dL (12.0mmol/L). I was unable to achieve any control so I suggested to the vet that we try a new insulin, she has been on Glargine since her diagnosis and this was the insulin she was severely overdosed on. I'm not entirely sure of the science behind it but perhaps she has developed a slight resistance to this insulin because of that 6 month period of excessive overdoses. The vet is not ready to give up on Glargine just yet, and I understand why because it does have such great success rates. She wanted to try one more dosage change before we go another-insulin-route.

-August 1st-August 19th: I was instructed to increase her dose to 2.5u ONLY when her BG≥216mg/dL (12.0mmol/L), and a similar outcome followed. I have a hard time understanding why she shouldn't receive an injection when she is at around 180-198mg/dL, otherwise she just continues to rise and then 12 hours later she is super high.

-I spoke with a stand-in veterinarian while my regular one was on holiday and she pointed out that same logic to me: that if Annie's midday numbers show an increase before her next pre-insulin test, then I should still shoot. So as of Aug 20, she has been receiving 2u every 12 hours (with exception of a couple really low numbers).

See for yourself on the attachment!
Maybe someone else can make sense of it. Unfortunately, the only glitch I'm coming across on the worksheet is that only sometimes my midday numbers are rounded up (i.e 15.6 to 16.0). I understand that I need to get more midday values, as my schedule begins to lighten I should be able do some more throughout the next week.

Please share your interpretation of these values if at all possible, and any advice/suggestions to help with the peeing outside her box would be great as well (I'm starting to fear that I won't receive my damage deposit back now!) She received a "precautionary" antibiotic shot in July without any real evidence of a urinary/bladder infection, so I'm wondering if she simply just loses control of her bladder because she has to pee so frequently? I know that tighter diabetic regulation will help with this.... we're working on it!

Thanks in advance for looking over her data and sharing your knowledge with me. Really appreciate it!

Julia
 

Attachments

Did you give a 2 unit dose the evening of 9/5 with eh preshot of 9.3? You should enter the dose in the column labeled U in the spreadsheet rather than in the Notes column.
The curve you obtained 9/5 AM is very good but the low of 3.4 is too low for liking.
Is Annie eating the same type and quantity of food all the time? I ask because sometimes not drop in BG is shown. Anything else that would explain the differences from one day to another?
 
Hi Julia,

I'm so sorry to hear that you and Annie are struggling to find the right dose. I'm not a dosing expert by any means, so I hope others with more experience will be along soon to help you with dosing. I did have a couple of thoughts based on what you wrote.

First, I agree with you that your vet's recommendations don't make much sense. Lantus dosing is based on the nadir (low point of the cycle) rather than the preshot number. Also, Lantus likes consistency, so numbers can get a little whacky when the dose is changed from one cycle to the next like your vet recommended. Most experienced Lantus users here will still give a shot when their kitties are above 50 or so - that's the "shoot low to stay low" motto of the Tight Regulation protocol. You're right - if you don't give a shot, the numbers are high by the next shot time. If you are going to shoot lower numbers, though, it's really important to monitor and get in those bg checks.

I personally think the AM cycle yesterday (9/5) was a beautiful cycle. The Lantus did it's job and brought Annie's numbers down into the normal/healthy range. On a human meter, our "cut-off" number is 50. Anything below 50 is considered too low so that 3.4 (61) at +5 was considered safe. (Since we don't know what Annie's nadir is - e.g., does she hit her low point at +5, +6, etc. - I may have gotten in another test at +6 just to make sure she wasn't continuing to fall.) The problem is that Annie's body isn't used to seeing those normal numbers anymore. When she got into those numbers, her liver panicked and released lots of extra sugar. That's called bouncing - and that's why you saw that Annie's glucose went up and stayed high during the PM cycle. Here's some more information about bouncing written by one of our members, Julie & Punkin: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46012. She talks about bouncing towards the end of the second post.

Getting in some of those extra tests will really help us see the bigger picture on what is going on with Annie. Is it a good dose? Does it need to be raised? Is Annie just bouncing a lot? Even getting just one extra test in per cycle will help answer some of those questions.

For what it's worth.......my vet was not very knowledgeable about feline diabetes. I ended up joining the TR forum here. Each day, I posted Jersey's numbers and let the experienced users guide me with dosing. They would help me figure out when to increase, decrease, etc. We were very fortunate that Jersey went into remission after just a couple of months on Lantus. I really believe we wouldn't have been able to do that if I had followed my vet's recommendations. I know how hard it is to hear one thing from your vet and then read completely different opinions here. It's confusing and quite frankly, overwhelming, at times. Hang in there! :YMHUG:

Shelly

EDITED TO ADD: If you could put the dose you gave Annie in the blue "U" columns on the spreadsheet, like Larry mentioned, that might make it easier for others to read it. Hopefully they'll be along soon to add their thoughts and suggestions!
 
Thank you so much for your responses so far! I will be certain to update the graph with the doses in the required column. Thank you for catching that for me.

Larry and Kitties:
-Yes, she did receive 2u last night (9/5) when her preshot read 9.3. I was also concerned when I saw the 3.5 (61.2mg/dL) reading. Today I got an even lower number at +9 when I got home from work about an hour ago :(

AMPS= 16.8 (302.4mg/dL) **2u dose**
+9= 2.8 (50.4mg/dL)
+10= 4.4 (79.2mg/dL)

I gave her a snack right away after I saw that +9 value. I really hope that she didn't reach her 'nadir' while I was not home, how frightening to think that she could have been even lower than that...I will continue to check every hour now tonight.

- Annie is fed Purina DM wet food. She gets 1/2 a can every 12 hours with her insulin shot, and I will often give her 1/4 can as a snack sometime in the middle. The snack time can vary... for instance, yesterday she had her snack at +5 and today she had it at +9. Should she be receiving it at the same time from this point on? Or not receiving it at all? She is always so ravenously hungry and pesters me like crazy for food throughout the day.

-Another possible explanation for the day-to-day differences could be the injection timing. I was told by my vet that the injection time can be stretched to no more than an hour. I aim for 7:30am and 7:30pm everyday and I am consistent with this in the evening; however, mornings can vary to 6:45am or 8:00am.

Shelly & Jersey:
Thank you for your information. I wish that this was better understood months ago! Would it be safe to assume that her 'nadir' is too low and she could require a lower dose? Or is it too soon to tell with too little information? Numbers like 61.2 and 50.4 are a little concerning for me, especially when I am not home for her. How long should I stick with the 2u dosage before it becomes obvious that a change is necessary?

Interesting and very useful to learn about the 'bouncing' concept. I was cussing at myself last night over her PM cycle because I just assumed that I gave her shot 'intrafur' and that's why her numbers continued to rise. Glad to see that maybe I'm not such a failure after all!

Amazing that you got your Jersey into remission, how rewarded and relieved you must have felt! I have felt very discouraged these last few months with my sweet Annie, remission hasn't even presented itself as a slight possibility....we can't even get her regulated :( I think I'm just going to stick around here for a while and try out what the forum suggests for us next. Unfortunately, the advice I'm receiving from the vet hasn't proven to be effective and this has all been at Annie's expense. Poor girl has been through so much in her life, I want to help her so badly. Just tell me what to do and I'll do it!

Thanks again for your responses. I will continue with updates on the graph that will have more midday values. Hopefully I receive a bit more feedback!
 
Glad to see you, Julia, and great job getting that +9 today! I'm not a dosing "expert" by any means, and I've asked some more experienced users to take a look. My initial reaction was to decrease the dose after that +9 of 50, but let's hear what others think first.

Just some additional thoughts -

Ideally with Lantus, shot times should vary by no more than about 15 minutes. I know that can be really hard to do when you're juggling work and all of your other responsibilities. If you shoot early, though, it's like a dose increase. If you shoot late, it's like a dose decrease.

Most members here actually recommend feeding several small meals a day. It's easier on the pancreas to handle these smaller meals as opposed to just a couple of larger ones. What I have most often seen is that people will feed at shot time, at "+1," and at "2." It's recommended to try not to feed after nadir, since the insulin is wearing off at that point. (Of course, if numbers are low, you should feed regardless of the time in the cycle.) I was a weak mama - I pretty much fed Jersey whenever she wanted. ohmygod_smile The only time I absolutely did not feed her was the two hours prior to her shots. (We don't want the pre-shot numbers to be influenced by food.) Since diabetic cats can't get all of the energy they need from their food, they often need to eat more. As they become better regulated, their appetites slow down a bit. At times, I thought Jersey would eat through the Fancy Feast cans. Right before she went into remission, I couldn't get her to eat. :roll: Lots of people here also buy timed feeders to use when they have to go to work. We can get you some links to those if you're interested.

Those bounces are one of the toughest parts of this dance, in my opinion. Jersey was a very bouncy kitty. We would see good numbers and then it would be days before we saw them again. It looks like Annie cleared her bounce in just one cycle, which is great!

There's no doubt - we were extremely fortunate that Jersey went into remission. I really do credit the people here with our success. What's amazing is how many kitties I've seen go into remission since the short time since I joined FDMB. I've seen cats go into remission after being on insulin for just a few days, some for a few months, and some for a few years.

Shelly
 
Oops - one more suggestion to throw out there at you. If you can post a link to your spreadsheet in your signature line (rather than inserting it in your post), that can help others more quickly access your numbers.

Here are some directions about setting up the spreadsheet. Linking it to your signature line is located near the bottom of the list.

1. First of all, you’ll need to set up a Google account if you don’t have one already. Here’s the link for it: https://accounts.google.com/SignUp?continue=https://accounts.google.com/ManageAccount

2. Once you set up your account, make sure you are signed in to it. Then click on this link: https://drive.google.com/previewtem...U5BVEdyU1dGZmx5bnRvdG10OWc&mode=public&pli=1#

3. This will bring up the template that you can use. In the upper, left-hand corner of the page, it says “Use this template.” Click on that.

4. Now you have your own copy of the template. At the top, left-hand corner of the page, click on “File” and then choose “Rename.” You can now change the name of your spreadsheet (e.g., “Cat's Chart”).

5. Once you finish entering the date, numbers, etc., you will need to publish your spreadsheet. Click on “File” again and then click on “publish to the web.” A little pop-up box will appear. You will want to make sure that the box that says “automatically republish when changes are made” has a checkmark next to it. Then click on “start publishing.”

6. Now, you need to make sure other people can see your spreadsheet. Click on the blue “share” button on the upper right-hand corner of the page. A pop-up box will appear. Where it says “private,” change that to “anyone with the link can see” and click save at the bottom of the box.

7. Now you have to add the spreadsheet to your FDMB account. First copy the web address that appears in the address bar on your spreadsheet. Come back to FDMB and click on “User Control Panel” at the top left-hand side of the page. Then click on the tab that says “Profile” Next, click on the tab that says “Edit Signature.” There’s a little “url” button at the top of the box where you write. Click on it. This is what will show up in the box:



Click in between the middle brackets and paste the web address for the spreadsheet that you created.

In the end, it will look something like this: https://docs.google.com/spreadsheet/.....[url] Let me know if I can help! Shelly
 
Those were incredibly simple instructions, thank you so much for that. I now have the link included in my signature!

As for these automatic feeding dispensers, are they available for wet food? I do have the Purina DM dry food as well for her but I rarely give it to her, mostly just the wet stuff. I'm afraid the dry food will have too much of an increasing effect on her BG. Also, what kinds of Fancy Feast are acceptable for diabetic kitties to eat?

How hopeful that makes me that there are cases of kitties that have been on insulin for years and can still achieve remission!

Looks like she may be experiencing another bounce tonight?

Thanks again, talk soon :)
 
Hi Julia

Shelly asked me to pop over from Lantus Land (Lantus Tight Regulation forum). Thanks so much for doing the Spreadsheet and linking it in your signature. Did you do the World version? With the World version, you enter the numbers in from your meter (intl numbers) and it will convert it on a second SS to US numbers.

First, please be sure and get a +2 test for your sweet girl tonight. Her +1 test is not really showing a food spike and so I am concerned she might come back down on you. A +2 test will give us an idea of what she might do. If the +2 test is much greater than the preshot, it's likely to be a quiet cycle. If it's the same, similar to, or lower than the PS, you should be prepared for a potentially very active cycle.

I have some other thoughts for you but want to be sure you see this and grab a +2 test.
 
Hi Julia,

Thanks for your kind words about the instructions. I made a huge mistake when I sent them to you, though. :oops: Instead of giving you the link for the template that shows both world (mmol) and U.S. (mg/dl) numbers, I sent you the link for just the U.S. numbers. I’m so sorry about that! If you want to use the world template, you’ll enter the world numbers, and it will automatically convert them to U.S. numbers. Here’s the link to the world template if you want to change to it:

https://drive.google.com/previewtem...abetes.com/FDMB/viewtopic.php?f&pli=1&ddrp=1#

Again - my apologies. I'm just so used to giving the instructions to those who are using the U.S. numbers that I didn't catch it before posting them to you. You did a fantastic job getting it set up and adding it to your signature.

Some of the automatic feeders do have compartments under them where you can add ice to keep the food fresh. Many people simply add some extra water to the canned food to keep it fresh. Others will freeze a block of canned food. By the time it gets to feeding time, the food has thawed out. Here's an example from Amazon of one of the feeders a lot of people here use: http://www.amazon.com/PetSafe-5-Meal-Automatic-Pet-Feeder/dp/B000GEWHNS?tag=felinediabetesfdmb-20. I know there are several different types available, though.

Have you seen Dr. Pierson's food chart list? Here's a link to it: http://www.catinfo.org/docs/FoodChartPublic9-22-12.pdf You're ideally looking for foods that are less than 10% carbs. Most of the Fancy Feast classic pates fall into that category. Try to avoid foods with gravy; the gravy is high in carbs. With that said, you'll want to pick up a few cans of gravy foods. They can be used to help bring up Annie's numbers if she goes too low. If numbers go too low, we steer with food and/or Karo syrup (corn syrup). Do you have some of those items on hand? Maple syrup, Karo, honey....any of those are good in case of emergency.

Annie might or might not end up bouncing tonight. Since we don't yet know Annie's patterns, it's hard to say right now.

Okay, I don't want to overwhelm you with too much at once. What questions do you have?

You're doing great!
Shelly

EDIT: I cross-posted with Marje. Marje is one of our most experienced Lantus members here. You're in great hands with her (although I'm not leaving you)!
 
Lol, no worries! It was simple enough to just copy and paste from the previous template that I uploaded initially (it would automatically convert the values to the U.S version for me). I will update my signature to the Canadian one shortly :)

As for Annies +2 test, it did slightly increase to 149.4. I can complete both a +3 and +4 tonight as well before I go to bed.

Interested to hear your thoughts, Marje & Gracie. Thanks for taking the time to help Annie!
 
Glad to know it's not a huge problem to change it. ohmygod_smile

You're doing a great job testing! These numbers are telling us a tremendous amount about the dose.
 
I've been studying Annie's SS. First, let me say how very much I admire you for giving her a chance. FD can be challenging but to deal with the other issues she has due to the overdose....well, you are a very special person.

Are you giving her methylcobalamin for her neuropathy? We recommend Zobaline. It is FD friendly and works very well to address neuropathy.

Here's what I'm seeing from her SS:
--the dosing your vets have recommended has resulted in a lot of inconsistencies. Lantus is a depot insulin and it works best when you shoot the same dose every 12 hours unless a dose increase or reduction is required or if the kitty is below 50 (in that case, we stall and shoot the rise). We have very specific guidelines for when the dose should be raised or lowered but the more consistent a caregiver is with dosing, the better.
--I think she is getting low on you still. For example, on 9/1, she was coming down probably most of the day. It's possible she got lower than 74 because she bounced so high the next day. When you don't test at night, you are missing half your data and cats often go low at night. We always recommend a preshot for every single cycle, and then, for the day, a +2 and/ or an out the door test and an in the door test if you are work. At night, preshot, a +2, and a before bed. If she's dropping during any cycle, more tests will be needed.
--cats can start at 300 at the morning PS, be at 40 midcycle, and be back at 300 at the evening PS. Without tests during the cycle, you might think she needs more insulin when she needs less.
--you've done a great job testing the last two days!! Well done, you!!!

I suspect she has probably gone below 50 on this dose but for long-term diabetics, the reductions are given if she goes below 40 once or drops between 40-50 on three separate days. I usually advise members that they should not go to bed for the night on a dropping number....they need to test until the number is coming up without food.

You have two choices:
If you can continue to monitor her as you have been doing, you could hold the dose until you catch the reduction numbers OR
You can reduce her dose to 1.75u bid and see how she does....but you'll still have to monitor more than you were before 9/5.

We can help you learn to safely shoot the lower numbers, above 50. Questions? I've thrown a lot at you.

And it looks like she might decide to take it easy on you tonight. :-D
 
That food chart has got some great information. I am fortunate enough to have the cost of Annie's special DM food covered, otherwise I think it can get pretty pricy... but since I'm likely to never give Annie up for adoption and instead keep her forever as my own (failed foster mom), it would probably be wise to be aware of some other more affordable alternatives for her.

I do have corn syrup available for emergencies, and I've been lucky enough to never have to use it in the 6 months that I've had her. I have often just given her some food or her DM kibble to help raise her numbers.

I really do have a hundred questions...and I'm still trying to wrap my head around the misinformation that I've been receiving over the last 6 months. I guess my main concerns with her will start to improve once her numbers become more normalized...such as the frequent urination outside her litter-box and the weakness in her legs. She is shaky when standing and sometimes her legs will buckle beneath her. I will absolutely consider Zobaline, as she is not taking anything for the neuropathy, and I may need assistance with the dosaging for that as well!

Thank you for spending some time interpreting Annie's SS. Deciding between reducing her dose by .25 waiting to see those reduction numbers is a tough call...I don't want to see those reduction numbers! Below 40 terrifies me....But I would like to see how this 2.0u dosage behaves on more consistent terms and with more midday values. I understand now that the shoot time is only as flexible as 15 minutes (not an hour), so those varying times have to have been altering her data.

I'm curious to know what a desirable trend should look like and what the acceptable range for the 'nadir' is. How long does it take for kitty's system to adjust to a new dose and start displaying accurate values that follow a clearer pattern? I am interested to learn more about 'stall and the shoot the rise' and how to shoot safely on a low number.

P.S. Her +3 tonight was 181.8, so I suppose I can go to bed now!

Thanks again Marge & Shelly. I really look forward to working with you both, and really appreciate all the time that you two donate to this cause. Annie and I are really thankful!

Will update my SS tomorrow with more values...in my Canadian language ;)
(I'd never even heard of the unit mg/dL before this website! at least it's an easy conversion)
 
I will come back in the morning and provide you with some more info. My Gracie is running low tonight and I need to focus on getting her numbers up so we can rest. But I promise I will post some more info and answer questions in the morning.

Yes..I think it is safe now for you to sleep. Glad you found us!
 
Good morning, Julia! ~O) I hope you and Annie are doing well this morning.

See, that's why I don't foster kitties. I would end up keeping them all. :lol:

If you are looking at foods, it may be time to consider getting rid of the dry completely (although it can be used for low-number situations if need be). Is the dry Purina you're feeding called the DH? According to Dr. Pierson's food chart, that one is about 31% carbs. I think the DM canned is one of the few prescription vet foods that is actually acceptable (per our 10% carbs or less "rule"). I know you said that you rarely feed it to Annie now, but it's one more variable we can take out of the equation if you can eliminate it completely. Lots of cats often need less insulin once they're completely off the dry food, and there have been some members who were able to get their kitties into remission just by switching to low-carb canned food. If you have to have a dry food option, there are only a couple of low-carb dry foods that I know of (Young Again and one of the Evo formulas, I think). I have the Young Again on reserve in case I have to make an emergency road trip.

Sorry we all missed the question in your first post about the litter box issue. Jersey did urinate outside the litter box, but that actually stopped soon after we started giving her insulin - even though we hadn't yet reached regulation. Thinking about it, I don't think I've ever seen a discussion here about how long it takes to get back to normal litter box habits. :? Hopefully someone else can chime in on that one. I'm also wondering if the neuropathy may be playing a role. If it's hard for her to get into the litter box, is that why she's still urinating outside of it? Do you have some type of shallow tray you could use as a litter box to test out that theory? Jersey was fortunate not to have neuropathy so I don't have any experience with the meds. Marje and others will be able to help you with the dosing, though. When you're ready for it, just give a shout out.

Just a few more answers to some of your questions. I'll let the more experienced users help you with some of the specifics.

-We consider normal glucose ranges between about 50 and 120 (U.S.). If you're getting nadirs and pre-shots in that range, that's fantastic.

-Since Lantus is a depot insulin, it can take some time for dose changes to take effect. For instance, if you reduce, you may not actually see that reduction in the current cycle since the depot is still in play. When you increase the dose, sometimes the numbers can actually go up initially. That's what we call New Dose Wonkiness (NDW). Here's more info on it: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46012. (It's the same link I gave you about bouncing.)

- There are a couple of different groups on this site for Lantus users. One is the "Relaxed" forum, and the other is the "Tight Regulation (TR)" forum. If you decide to go with TR, there are some standard protocols that are followed. For instance, you re-evaluate a dose every 6 cycles (3 days). That gives you enough time, typically, to see how well a dose is working. With TR, you also have to make sure you're getting in mid-cycle tests (but you definitely don't have to test every hour.) TR also encourages shooting low numbers. The Relaxed forum isn't as strict, for lack of a better way to say it. Members there might hold doses longer, etc. Once you get settled in, you may think about which one of these approaches is best for you. You can then start posting in that forum each day so experienced users can see the daily numbers and help you figure out the next step. Let us know when you're ready for that step, too, and we'll give you the info on how to set up your "condo" (post).

Okay, I know that I didn't answer all of your questions, but I hope this is a start. If you get a low/lower pre-shot number than you've had, you can post here and ask for help before you shoot. You can change the subject line of your very first post in this thread to ask for help (e.g., Help - Stalling Annie). If you're dealing with an emergency (e.g., Annie's numbers drop below 50), you can go back to the first post in this thread and click on the little "911" icon. That will bring attention to your post. Just remember to make the change in the first subject line in the very first post. That way, it will show up on the main page. (If you edit the subject line of your other posts in this thread, those changes don't show up until you actually "enter" the thread.)

Will update my SS tomorrow with more values...in my Canadian language ;)
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ohmygod_smile I know, I know. I did a bad thing by giving you the wrong link yesterday. ohmygod_smile

Wendy (& Neko) is also a really experienced Lantus member who helped us with Jersey. She's from Canada, too. If she stops by, she can commiserate with you on those irritating U.S. people who give Canadian people the wrong template :lol: :lol: :lol:

Shelly
 
Julia

Shelly gave you some good info. She beat me to it this morning but I'm glad. Miss Gracie and I had a PJ Party last night so I'm slow getting started today ;-)

Thank you for spending some time interpreting Annie's SS. Deciding between reducing her dose by .25 waiting to see those reduction numbers is a tough call...I don't want to see those reduction numbers! Below 40 terrifies me....But I would like to see how this 2.0u dosage behaves on more consistent terms and with more midday values. I understand now that the shoot time is only as flexible as 15 minutes (not an hour), so those varying times have to have been altering her data.
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No one wants to see their kitty in those lower numbers, and some kitties do earn reductions by being in normal numbers (generally 50-100) for one week. But remember that as long as you are testing and you have food, you can manage the curve and bring the numbers up. As an example, little Miss Gracie was down to 34 last night but I had been testing and caught it quickly, gave her high carb food and karo, and she came up to safer numbers. Poor Annie evidently has been down in those numbers many, many times with her previous foster mom. I imagine the vets raised her doses way too fast and too much because they did not understand the action of the insulin.

Some times we do need to stall shots to let the numbers come up and if numbers are high, we can shoot early but these are advanced techniques that we could teach you and you will learn when it is appropriate to not shoot a 12/12 schedule and how to get back on it.

I'm curious to know what a desirable trend should look like and what the acceptable range for the 'nadir' is. How long does it take for kitty's system to adjust to a new dose and start displaying accurate values that follow a clearer pattern? I am interested to learn more about 'stall and the shoot the rise' and how to shoot safely on a low number.
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As Shelly said, normal numbers are 50-120 on a human glucometer. I think we missed asking you last night if you are using a human glucometer or an Alpha Trak from the vet because it does make a big difference. If you're using an AT, we need you to reduce the dose by 0.25u. While we like to see our cats in normal numbers, a cat is considered to be wellregulated if numbers are typically under 200 and nadirs are often 100 (on a human glucometer) with no symptomatic hypoglycemia. That would be my first goal with Annie.....get enough data to see where she is in terms of regulation and what her dose needs to be. Then we can adjust it and see what happens.
 
Hello - waving Hi to you and sweet Annie from across the pond. We have had a few members from Vancouver Island on here. I can feel your pain on the spreadsheet translations. Actually, if you use the World version of the SS here, it'll do the translations for you to the US numbers so you don't have to. :-D

Yikes on the 20U! Poor little girl. Neko has a high dose condition and she didn't get that high. But I was talking to a locum vet the other week and he told a story of some vet tech at a previous practice who had shown kitty caregivers the wrong dose, and it was 20U instead of 2. That happens way too often.

A couple of your questions might not have been answered. The Zobaline is once a day pilling, you can just easily crush the pill and add it to her food.

I got my automatic feeder from Amazon.ca, since Amazon.com doesn't deliver here, but it still caries most of the feeders people refer to here. I have the QPet one and it has a space for a gel pack. I serve raw food so need to keep it cold. Another option I've heard is to put a ice cube on the food. It'll melt and add water, which you should be adding to a diabetic kitties food anyway. A lot of the food options on the Catinfo list are available in Canada. The Fancy Feast one have different names, but stick with anything that says pate. The Wellness cans which several people feed have the same labels, as do the low carb Merck foods. I've been using the Merck Cowboy Cookout as a high carb food as Neko is sensitive to the wheat in the Fancy Feast gravy foods.

For LB issues, try to get something with a low entry and maybe higher sides. Some people here just get some of those large plastic storage bins and cut an entrance door for it. Neko has arthritis, so I just got her a low rider LB that she likes. Another option is to surround the litter box with pee pads for any, um, overflow. :lol: You can get washable puppy pee pads.

Keep asking questions - you said you had hundreds of them. Maybe I can help with local knowledge.
 
Good day!

Been busy at work for most of the day, I was able to jet home quickly though on break to get a +3 and give a little snack, I was concerned she would get as low as she did yesterday as her AMPS this morning was very similar to her AMPS yesterday.

I have updated my signature and entered her values from today, please see to make sure that all looks correct! Thanks :)

I will be sure to eliminate the dry DM from her diet completely. There is no real need for it anyway so I'd rather not run the risk of jeopardizing her numbers. Although, I do wonder whether it is ok to occasionally feed her the Fancy Feast Pate? Or is it best to stick to one food only (Purina DM Canned)?

As for the litter box, it is quite shallow and has no top to it, so she is able to get in-and-out just fine... I have seen her do it with no struggle. Peeing outside her litter box though, this I have never seen. From what I can gather...she does it only when I am not home. Like today, when I got home from work, she had completely soaked the newspaper that I have laid all around her litter box zone... and there were a couple little kitty turds scattered around the bathroom (yuck).

The neuropathy medication, Zobaline, is this something that has to be purchased online? Or can it be found at vet clinics/pharmacies/walmart?

I'm uncertain as to which method to use for Lantus dosing, the "relaxed" or the "tight regulation," which one has better results? Which one do all you girls use? My schedule can be a little wonky at times as I'm a uni student with a part-time job, but it does allow for 7:30am & 7:30pm injections. How many midday values I will be able to get will vary considerably day-to-day, so I don't know if this will effect which method I should choose.

Oh my goodness, Marje! 34 is scary low, thank goodness you were monitoring her so closely, I would have had a panic attack! Has Gracie ever had a hypoglycemic episode? You're right when you said Annie has reached those same numbers, she was consistently hypo for 6 months, I don't know how she survived it. Poor poor girl, for a long while she didn't even seem to have an interest in living anymore. She would just sleep all day, and only move for food/bathroom breaks. She wouldn't groom, play, purr, cuddle... but holy, did she ever used to yowl, all through the night she would stare blankly at the wall and just cry. She was just the saddest kitty in the world.

Now she is starting to take on more cat-like behavior...follows me into the kitchen, rubs her gums all against my legs, seeks out cuddles, greets me when I come home, nips at me when she's had enough of pets, explores the backyard. This is all relatively new behavior! So while her diabetes may not be improving at all, her quality of life seems to be at least. If we could just control her diabetes and stop her foster brother (Gus) from mounting her and trying to have his way with her...(even though he's fixed), then she could really live out her remaining years as the best of her life.

As for the glucometer, she is on a human one "Bayer Contour Next"

Wendy & Neko, I just saw your message now! Thanks for joining the conversation and lending your support to Annie & I! What a beautiful weekend we have had, the last stretch of summer for us before we get rained out for the next 7 months! The puppy pee pads is a great idea, because most of her incidents are occurring right around her litter box.

I can't believe that a vet tech would be so ill-informed to make such a life-threatening error on something as simple as reading the syringes properly. The poor woman who overdosed Annie was clearly not shown the right procedures and felt awful when she learned what was happening, the organization then took Annie away from her.... when it wasn't even really this woman's fault. Such a sad case.

Wendy, what kind of glucometer are you using? For my Bayer one, the test strips are very expensive (works out to be $1 for each test strip). I would like to find one that is more affordable, especially since I will be taking a lot more values throughout the day. Also, what pharmacy are you getting your Glargine from and for how much?

I'm rambling right now, so I will get back on track. How can her values from today be interpreted? I know it would have been nice to have seen a couple numbers between her +3 and +9 test. I find it strange how her morning cycle today appears so different from her morning cycle yesterday when there was such a similar starting point.

I'm sorry if my posts are too all-over-the-place, I will try to organize my thoughts and questions better!

Dinner time for me & the kitties. Will continue to update some numbers from her evening cycle, I am interested to see where it will go... I can't even speculate?? Talk soon! Thanks again for all your support :)
 
Spreadsheet is looking good to me. :-D Looks like Annie was bouncing today. Shelly gave you a post that explains what happens. It can take up to 6 cycles for kitty to clear the bounce.

The Zobaline is purchased online from LifeLink. US members can buy it from Amazon.com which doesn't ship here and Amazon.ca doesn't carry it. :roll:

I'm using the Relion Confirm meter as my primary meter and I get my strips from American Diabetes Wholesale online. Unfortunately the Relion is only available from the US Walmarts and ADW doesn't ship to Canada. However, I'm close enough to the border that I occasionally do a cross border shopping trip, and there are US post boxes you can get things mailed to just across the border. I do have a Bayer as a backup just in case I'd run out, but in addition to the price, I like the smaller drop of blood required by the Confirm. I have heard of people buying their strips on EBay for much more reasonable prices, so you might want to check that out.

For food, you don't have to stick to one, just try to feed foods in generally the same ballpark for %carbs. I rotate Neko's proteins between four of them, so she doesn't get bored. Not that she would - she puts a hoover to shame.

Marje/Shelly and I belong to the Tight Regulation(TR) forum. The protocol we use is the only scientifically researched and published protocol that we know of for treating diabetic cats on Lantus and Levemir. There is a higher chance of remission on that protocol if that is your goal. However, TR can be more intense as kitties tend to run in more normal numbers which requires more testing. There are people there who work long days, they rely on an autofeeder to feed kitty if they think she'll go low and do more testing at night or weekends to see how a dose is working. If you can get at least the preshot tests and one other test per cycle, that is all that's required for tight regulation. I am in TR, not necessarily with the goal of remission, but because she will be in better healthier numbers. Neko has a high dose condition called acromegaly which is a tumor on her pituitary gland so whether she goes into remission has to do with the tumor, not healing the pancreas.
 
Just checking back in on you and Annie to see how things are going!

I'm sorry if my posts are too all-over-the-place, I will try to organize my thoughts and questions better!
Click to expand...

They aren't! We know you have tons of questions and the more information you give us, the more we can help you.

Your spreadsheet looks great and getting in those "whenever you can" tests helps a lot.

Wendy already answered some of your questions, so I'll just add in what I can.

Once we started insulin, Jersey soon decided that she wanted to be a picky eater. Prior to the insulin, she was ravenous - eating whatever she could get her little paws on. Once we got rid of the dry, we fed Wellness Core. She didn't really care for it after a while (and it was getting expensive) so we switched to Fancy Feast classic pates in a variety of flavors. Then she got picky about which of those flavors she liked, so we switched to Friskies Special Diet. That worked for a while, but she got picky again. So now we're back to mostly Fancy Feast. As long as they're low-carb, you're okay using a variety of foods. We're really fortunate that our cats adjust well to a variety of foods; I know some cats have a bit of tummy upset when foods are switched.

It's great that she can get in and out of the litter box, although I know how frustrating it can be when she goes outside of it. We used puppy pads for a while, and Jersey was actually pretty good about using them. We just had a few accidents off the pads.

I'll admit - the TR protocol terrified me at first. I wasn't sure if I could do it, but I'm now so glad I did. Both my husband and I work. I tried to give the AM shot early enough that I could do a +2 check before I went out the door. If it looked like it was going to be an active cycle, I would leave out lots of food in our timed feeder and ask my husband to run home at lunch to do a check if he could; I teach and was in class at lunchtime. I did sneak home in between classes a couple of times to get checks when I thought she might go too low. (My boss was wonderful about that!) There are several people using TR who have really hectic schedules and can't always get many daytime checks in. You just do what you can - even if that's only a +2 or a +8.

Thanks for describing Annie's behavior now. It's so easy to get wrapped up in the numbers, and it helps to focus on the whole cat. We actually ask people to provide a "whole cat" report - are they eating, playing, purring, pooping, preening? That type of info can be very helpful, too.

Sounds like Annie was extremely lucky to find a home with you, and I personally think you've found the right place for help with her diabetes! :-D
Shelly
 
Hello again! Please take the time to see some more values from last night and from today. Not much activity going on with her BG...

I'm glad I can now give her some variety with her food. It must get boring having to eat the same thing everyday, all day... especially when Gus gets to eat Fancy Feast. I would occasionally give her little spoonfuls for a treat and she'd go bonkers for it, so now I am relieved that it will do her no harm and she can enjoy a bowl of Fancy Feast every now and then.

So after taking in the information I've been getting from you ladies and also from reading about the tight regulation protocol on tillydiabetes.net, this is definitely the route that I would like to take with Annie. I would like to take the approach that gives her the best chance of remission or at the very least, regulation. Under what circumstances do caretakers choose the 'relaxed' protocol?

Am I currently on the right track for the TR protocol? On http://www.tillydiabetes.net/en_6_protocol2.htm it is broken down into 5 different phases. Since Annie has been on Lantus for quite some time now (albeit, improperly), would she still be considered to be in Phase 1? Is 2u an acceptable starting dose? I noticed that they say the starting dose is generally kept for 3 days, I've held this same dose now since August 20th, providing quite a bit of data for the last 4 days especially. I certainly don't want to get ahead of myself before I have a good plan laid out with all the necessary supplies, but using all your best judgement...would you say she'd be ready for Phase 2? Too soon to tell? What kind of numbers should she be producing throughout her cycles that would qualify her for an increased dose?

Also, I am confused by learning that it can take some time for dose changes to take effect with Lantus, yet on TR the doses are re-evaluated every 3 days... 3 days does not seem like very much time to me? Especially when you have to take into account that 'New Dose Wonkiness' concept...

"Many cats will occasionally react to an increased dose with increased BGs - within the first 2 to 3 days after an increase, usually lasting for less than 24 hours. Nobody really knows what the reason for this phenomenon is (perhaps a "panicky liver"?) - hold the dose and ignore the fluctuations."

How can those numbers be re-evaluated accurately after only 3 days if they're affected by NDW?

It is a lot of information to understand! :oops: Doesn't anyone just have a magic wand that we can wave over our kitties to cure them of their diabetes???... (and their acromegaly in Neko's case!)

Talk soon. Hope you all had a good Monday!
 
The version of the TR protocol that we use is located http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581. It's based on the same research but reorganized a bit. Annie is not a newly diagnosed kitty, so even in the Tilley's page she wouldn't be stage 1.

I think you definitely could do the Tight Regulation Protocol. You might want to pop over to the Tight Regulation Forum, read the starred Sticky Notes at the top of the forum and even browse some of the posts there. When you are feeling ready for it, you could start daily posts over there. People chose the Relaxed protocol for various reasons. Some can't monitor every cycle, some work really odd hours. Some of the people posting there do mostly follow the TR protocol, but don't like the larger number of people on the TR forum. It can be a bit overwhelming at first - you'll get a number of people responding to your posts. The upside is that with so many people on TR, there's a good chance you'll find someone on most times of the day to answer your questions or help with urgent issues.

The 3 day cycle is enough time for the dose depot to fill and give you an idea of what sort of nadirs a dose will give you. The New Dose Wonkiness (NDW) typically lasts no more than a couple of cycles. And not every cat sees it or those that do may not experience it for every increase. When kitties are seeing blues and greens, we wait 8-10 cycles before increasing.

And yes, it can be rather overwhelming at first. It's like a short graduate course in feline diabetes. We've all been through the learning curve and can sympathize. We like answering questions. :-D

Neko had a sort of magic want waved over her. She went to Colorado State University and had Stereostatic Radiation Therapy on her tumor. Her insulins needs are much lower now and the growth hormone output of her tumor much less.
 
Hi Juila,

Just a note to say that after all that Annie has been through, I'm glad you found each other. Rooting for you both. :smile:
 
Julia

I'm sorry I didn't get back to you right away. I'm glad Wendy jumped in and Shelly kept up, too. We sometimes have to tag team with the help for new members :D

You are doing a great job of retesting and this is giving us some wonderful data. If Annie doesn't see more green in the next cycle or so, we can talk about increasing her dose. I'm so glad she was so blessed to find you and she is now able to live a normal and happy kitty life.

I think you are fine to feed her Fancy Feast classics as her regular diet. I believe they are all low carb and many members feed them routinely. Wendy explained why we hold the dose six cycles and just to underscore, part of the reason we do that is because we assume at least two cycles in the six can be influenced by new dose wonkiness.

Gracie has never had a symptomatic hypo. She likes to surprise me so we test a lot and if she dips down there, she isn't there long. The number at which cats experience symptoms of a hypo varies from cat to cat. I've seen cats in the 40s with symptoms like staring at a wall and I've seen cats in the teens with no symptoms. Of course, none of us want our cats in those low numbers....even when Gracie gets into the 40s, we want her up because there is no cushion.

Would you be ready to post over in the Lantus Tight Regulation forum now? There are many more of us to watch and help you with specific experience in using the depot insulins. To do that, just go to the FDMB main page, scroll down to "Insulin Support Groups", click on Lantus TR ISG and post a new topic. Hope to see you there.

We used to have a kitty, Max, who would harass one of our little females, Teddi in the same way your Gus does Annie. Max was also neutered but it was a control issue. We would put him in "time out" which was just putting him in a bedroom for 10-15 minutes. However he was very smart and he would pester Teddi and then run and hop up on the bed in the time out room :lol: :lol: :lol: he knew the consequences and accepted them. Have you tried Feliway diffusers? That did help with Max and Teddi.
 
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Thanks for your support, Critter Mom!

So, today I may have messed with the natural cycle a bit because I felt panicked by the number I got before I ran out the door...
AMPS= 86.4 (4.8) *2u*
+1= 84.6 (4.7)

I was going to be gone for the next 6 hours so I was concerned that she was going to continue to drop... it wasn't a huge decrease but after reading that a typical +1 is a bit higher than the preshot, I was thrown off as to where she would go from there! I don't have an automatic feeder yet so I left her a big bowl of wet food... and I sprinkled some dry DM Kibble on it :?

I continued to feel worried so I then asked my landlord to check her blood for me and that's where the +2 of 75.6 came from, she got another scoop of her wet food and I was able to make it home for her +7 of 129.6 (phew!)

Maybe I overreacted, and she probably got more food than what she needed... but that was the first time I'd ever shot on a green number so I got scared and I didn't have the time to consult with fdmb first.

When you all shoot on a green number (on the higher end of green), do you take extra precautions? When the number is already that low, you don't really want it to follow that normal curve in case it produces a scary nadir. What would you all have done in that situation?

I would be happy to start posting in the Tight Regulation Forum tonight, I may just start a new post tonight! Any pointers before I do? Any jargon I should be familiar with?

As for the Feliway, I have not tried the diffusers but I do use the spray... with little success. Poor Annie, just another unfortunate thing she's got to deal with... a horny male trying to have his way with her! And just like Max, he knows that he's not supposed to do it! So he'll wait till I'm distracted, and as soon as I hear Annie start crying and I run over to them, he's long gone. Bad boy, I did not raise Gus to be a sex offender!

Thanks again for all of your help. Annie sends her love!
 

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Yep - if you're going to be shooting low like you did this morning, you definitely need to make the move to the TR forum.

Here's the basic format:

Start one new post for each day. Put the date, your cat's name, and your readings in the subject line. Then you can just update the subject line with the new readings as you get them.

For example: 9/9 Annie AMPS 86, +1-84

We also try to link to our previous post. To do that, click on the little url tab at the top of the message box and then paste the web address for the previous day's post in between the little url brackets that appear. (Don't worry if you can't get that figured out right now. I'll be happy to link back to your previous post once you get something posted in TR.)

I would definitely start a post in TR tonight if you can. There are people on there almost all of the time who are experienced with Lantus and can help you if you have any questions or run into any "uh-oh's" like you did this morning.

Be sure to post your questions tonight in your TR intro (e.g., about shooting green numbers). We'll make sure they all get answered.

...And there's a ton of jargon in TR.....but we'll help you learn it as you go.

Love the pic. :-D
Shelly
 
Annie is truly bea-u-tiful! :smile:

Shelly beat me to it! I was going to recommend you post in the Tight Regulation forum for advice on how to handle low numbers. You'll get lots of help there.

Sending Annie some scritches ... cat_pet_icon
 
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