Initial Treatment Question

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Riddler

Riddler

Member Since 2016
Just started giving Brutus, my 10 year old male domestic short hair, Lantus in 2.5 unit doses (2x daily). Pre-treatment his BG (measured with an Alphatrak) bounced around between 330-400. He was 359 before the first shot, 277 nine hours later, when I administered the second shot (I did a short shot in order to get on a realistic schedule the next day), and 111 four hours after that (I checked because I wanted to make sure that nothing went wrong with the 3 hour overlap with the first shot). However, BG since then at the next two 12 hour shot times has been 387 and 431 respectively. He is a big cat (20 pds before the condition developed, 15.5 now). One last fact, for the last two shots, Brutus was moved to a new house (where we can treat him more reliably), so I wonder if stress has been a factor with the last two shots.

Anyway, I will speak to his vet later today, but I am assuming that we know enough now to increase his dose to 3.0 units, with suitable monitoring. Also, could he have something else going on that would make him particularly resistant to Lantus, or insulin in general? Is there a good chance that maintaining the same dosage will bring his numbers down significantly in time, either because of some accumulative effective that takes several days, or for some other reason? He been distinctly low energy and low appetitite for about 4 weeks (the period over which he lost the weight), so I am anxious to get him some relief (and hopefully see his normal, occasional burst of energy again).
 
PS Brutus

Before we started insulin, Brutus had two blood tests (including fructosamine @ 540) and a urine test. The urinalysis confirmed glucose in the urine, but no ketones or bateria. I was told that the blood tests were negative for pancreatisis or any thyroid problem.
 
Stress can cause a rise in BG. How long has he been getting 2.25 units? Unless you are following the tight regulation protocol, you should wait at least one week before increasing the dose. It takes that long for a cat's body to adjust to dose changes. Was 2.25 his starting dose?

What are you feeding him? Diet also affects glucose levels.
 
Riddler said:
Just started giving Brutus, my 10 year old male domestic short hair, Lantus in 2.5 unit doses (2x daily). Pre-treatment his BG (measured with an Alphatrak) bounced around between 330-400. He was 359 before the first shot, 277 nine hours later, when I administered the second shot (I did a short shot in order to get on a realistic schedule the next day), and 111 four hours after that (I checked because I wanted to make sure that nothing went wrong with the 3 hour overlap with the first shot). However, BG since then at the next two 12 hour shot times has been 387 and 431 respectively. He is a big cat (20 pds before the condition developed, 15.5 now). One last fact, for the last two shots, Brutus was moved to a new house (where we can treat him more reliably), so I wonder if stress has been a factor with the last two shots.

Anyway, I will speak to his vet later today, but I am assuming that we know enough now to increase his dose to 3.0 units, with suitable monitoring. Also, could he have something else going on that would make him particularly resistant to Lantus, or insulin in general? Is there a good chance that maintaining the same dosage will bring his numbers down significantly in time, either because of some accumulative effective that takes several days, or for some other reason? He been distinctly low energy and low appetitite for about 4 weeks (the period over which he lost the weight), so I am anxious to get him some relief (and hopefully see his normal, occasional burst of energy again).
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Welcome

Lantus can take several days before the body becomes acclimatized to it. It is not recommended changing the dose for the first week of starting and then dose increases WHEN NEEDED are done in 1/4 unit dose increases. Shots are done at 12 hours apart. Doing a shot only 9 hours after the first shot could have caused Brutus's glucose to drop much lower than his body was used to, which can cause a rebound "bounce" into higher numbers. Bounces can take up to 3 days to clear during which time numbers may appear to be high, but doses should NOT be increased at this time. Sometimes too much insulin can give high numbers the same way too little of insulin can. Starting a spreadsheet and doing regular testing before each shot and during the cycle (time between shots) can tell if the dose is working,


ETA Even in a non-diabetic kitty glucose levels will naturally fluctuate during the day. Glucose levels are not a static reading
 
Tuxedo Mom said:
Welcome

. . . cause a rebound "bounce" into higher numbers. Bounces can take up to 3 days to clear during which time numbers may appear to be high . . .
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Hopefully, stress and an initial "bounce" (caused by my doing the early short shot) are at work. Thanks for the call to patience. I'll give it the remainder of the week before trying to draw any conclusions.

I'll admit though, the diagnosis is a real bummer. Brutus has always been a super low maintenance cat, even while spending his last several years in a rural environment where outdoor hazards can cause problems for a less stout and savvy pet. I wish I had known more about the hazards of dry food, which composed about 2/3rds of his diet until now (he's exclusively on a low-carb wet diet now). With the ease of home BG testing, I would have checked his BG long ago myself, and in the process hopefully detected a potential problem before he suddenly showed obvious signs 4 weeks ago.
 
Hi jr. Like you I am reluctant to sign onto "internet" stuff without knowing what I'm getting into too but I assure this is safe and doesn't involve you putting any personal information at risk. It provides a safe and secure place for the spreadsheet (no worries of losing the document because of computer failure) and we use Google docs so anyone with the link to the document can view it and if you need assistance, offer you suggestions based on current data as to how to best help Brutus. Without access to the spreadsheet through the web, you would have to attach an up-to-date copy each time you needed any advice and it would have to be in a format anyone could use. Otherwise you could be left without assistance because a helper doesn't have the right software to view your attached document. This really is safe and the easiest way to take advantage of the vast amount of knowledge on this board. :)
 
If you already have a Google account, like Gmail, you can use the same credentials to log in and use Google Sheets (or any other Google service, for that matter).

You'll see that people have links to their spreadsheets in their signatures (well, not me - my cat went into remission before I could get one properly set up). Using Google lets the spreadsheet be online all the time - like Linda said, if someone has the link, they can look at it. This can be especially important in an urgent situation, such as low blood glucose numbers - you don't want to be trying to upload your latest spreadsheet while trying to help your kitty.

Another plus of the Google spreadsheet is consistency - everyone is using the same format, so when you need help, it's easier for the experienced members to look at the spreadsheet and figure out what's happening as it's in a format they're used to looking at on a daily basis.

I'm another person who is reluctant to sign up for many internet services (eg. I don't have Facebook, Twitter, etc), but I have had a Google account for many years and never had an issue.

Hope that helps reassure you a bit. :)
 
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Riddler said:
The link takes me to a Google page, which asks that I sign up to something, which I am reluctant to do. Can someone send me the Alphatrak calibrated spreadsheet by private message? Thanks, jr
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It took me 3 months before I was comfortable opening a Google Docs account. However it is safe and it is such a great visual aid for looking at trends and test data.

The link for the AlphaTrak2 meter spreadsheet (US format) is here:

https://drive.google.com/previewtemplate?id=1tJGUgovPVu6ddmQZRcJAenda_9XG7xPuX6Xtp7ed-M0&mode=public

You would still need to set up a Google Docs account and follow the instructions for sharing it, so that people here can see your data in order to offer advice.


The diagnosis of FD is somewhat overwhelming in the beginning. I have two FD kitties, brother and sister. Tuxie was diagnosed 1 1/2 years ago and has other health issues so he is VERY hard to regulate. I was testing his sister Maxie every month or so even though her bloodwork was fine, just because her brother had diabetes. One test she was perfectly fine then a 1 1/2 months later she was diabetic...3 months ago. Both kitties eat a low carb home made and were not overweight. Sometimes FD just happens no matter how diligent you are.

With changing Brutus's diet to all wet low carb you have taken an important step in controlling the diabetes. We have had many members whose kitties were actually able to go off insulin with removing dry food from their diets. This doesn't always happen, but you are definitely on the right path. With the diet change, home monitoring and doing safe dosing changes Brutus should show some good results. But..it can take time and patience is always something we need. It is better to do slow increases, when indicated, than try to rush the treatment and risk a chance of a hypo.
 
Tuxedo Mom said:
matter how diligent you are.

With changing Brutus's diet to all wet low carb you have taken an important step in controlling the diabetes. We have had many members whose kitties were actually able to go off insulin with removing dry food from their diets. This doesn't always happen, but you are definitely on the right path. With the diet change, home monitoring and doing safe dosing changes Brutus should show some good results.
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Thanks for the kinds words. Brutus has always preferred wet food anyway (before, he was able to get it out of me 25% of the time), so that "change" has been easy.

I'll be glad when his numbers come off the 330-390 BG (540-600 fructosamine) that he was showing before we started treatment Saturday. Although his overall behavior has been normal, he's been moving in slow motion, if you know what I mean, since this all started. I'm anxious to see him get his energy back. I'll post again when he does!!
 
Riddler said:
Thanks for the kinds words. Brutus has always preferred wet food anyway (before, he was able to get it out of me 25% of the time), so that "change" has been easy.

I'll be glad when his numbers come off the 330-390 BG (540-600 fructosamine) that he was showing before we started treatment Saturday. Although his overall behavior has been normal, he's been moving in slow motion, if you know what I mean, since this all started. I'm anxious to see him get his energy back. I'll post again when he does!!
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I know you are hesitant about opening a Google doc account. Until you feel more comfortable you can certainly list the numbers you are getting in a post....you will of course be advised to get a spreadsheet going ;)...but you can still post if you have questions or concerns about the testing numbers. If you list data just give info such as:

AMPS (AM preshot) +2 (2 hours after shot) +4 (4 hours after shot) etc.

As I said I also hesitated about downloading the Google docs spreadsheet from here...but it is totally safe AND so very useful and handy for looking at the data.
 
I just wanted to add that you could just create a "puppet" email account with google and not put in any of your real information--I've done that before with places I don't trust that want my personal information. But Google is a safe/secure website, and if you "publish" your spreadsheet like in the instructions people can view it without having it linked to your personal info in Google. The spreadsheet is an invaluable tool for several reasons. It lets you visualize your data well, it allows the experienced Lantus users on FDMB to give safe and accurate dosing advice, and you can also easily share it with your vet if you need to--when Bandit was on insulin the last time, his vet would check on his spreadsheet once a week and send me an email with his comments on how I was adjusting Bandit's steroid and insulin doses. Doing tight regulation with the steroids on board were throwing me for a loop (steroids make BG really wonky), it was great to have his input.
 
Spreadsheet is up. Thanks for the nudge. It is a great tool.

I almost certainly screwed up the start of Brutus' treatment by beginning at an workable time, and then shorting the interval for the next dose (i.e., only 9 hours) to get on a better schedule. I should have skipped the second dose altogether and picked up the next day at the appropriate time. That, plus an inadvertent temporary .5 U increase in dosage, looks like it may have caused him to bounce right out of the chute. My vet says just stay the course until Saturday, when we'll try to run a curve on him at home and see what's up.

The one bit of good news is that he currently seems stable clinically. His behavior (including appetite), weight (after the initial loss pre-treatment) and water consumption (4-5 oz/day) appear ok. He just continues to move slower, and sleep more, than we're used to. Plenty of unsolicited interaction and purring, just no occasional, spontaneous bursts of energy like were accustomed to. When I see that (which has been missing during the 4 weeks pre-treatment), I won't need a meter to know that his numbers have likely improved. The wait, even for a week or two, is frustrating, but I'm learning, often unavoidable.
 
Riddler said:
Spreadsheet is up. Thanks for the nudge. It is a great tool.

I almost certainly screwed up the start of Brutus' treatment by beginning at an workable time, and then shorting the interval for the next dose (i.e., only 9 hours) to get on a better schedule. I should have skipped the second dose altogether and picked up the next day at the appropriate time. That, plus an inadvertent temporary .5 U increase in dosage, looks like it may have caused him to bounce right out of the chute. My vet says just stay the course until Saturday, when we'll try to run a curve on him at home and see what's up.

The one bit of good news is that he currently seems stable clinically. His behavior (including appetite), weight (after the initial loss pre-treatment) and water consumption (4-5 oz/day) appear ok. He just continues to move slower, and sleep more, than we're used to. Plenty of unsolicited interaction and purring, just no occasional, spontaneous bursts of energy like were accustomed to. When I see that (which has been missing during the 4 weeks pre-treatment), I won't need a meter to know that his numbers have likely improved. The wait, even for a week or two, is frustrating, but I'm learning, often unavoidable.
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Congratulations on getting the spreadsheet up. It is such a great visual tool. Lantus usually has an onset at +2 hour after shot and a nadir (lowest number) around +6. This of course can vary with each kitty, but that gives a general idea of timing. Testing should be done before each shot, to make sure that the number is safe to shoot. Sometimes a kitty can throw out low numbers out of the blue, so doing a preshot test will let you know if this is the case. Also depending on your schedule it would be good to get another test during the day..even if at +2, if that works for you. Another test that gives good data is an evening test before you go to bed....at +2 or +3..whatever works best for you. With the data in between shots it can tell you how low the Lantus is getting Brutus. Dose changes with Lantus are based on how low the dose gets your kitty. Sometimes you will see a high AMPS and a high PMPS but the numbers could have dropped quite a bit in between. Whatever extra tests you can do give some very useful data.

Glad you are running the curve at home. A curve done at home gives a much better indication of the glucose numbers without any stress involved, as most kitties do have at the vets.

When you are doing the AMPS and PMPS readings, do not feed for 2 hours before the test. If you feed then the food can artificially inflate the numbers.

You are off to a great start. Brutus is a lucky kitty. ;)
 
It's not unusual when treatment is started for the cat to act "off"....we seem to hear it a lot that at first cats seem to sleep more than usual. I figure they probably have to feel pretty crummy since their body had gotten used to living at a certain glucose level and now we're trying to change that

As he gets better regulated, I'm sure you'll see him acting more like his old "younger" self
 
My "excuse" for not testing more frequently or with ideal timing is two fold. First, my lovely wife, who actually used to work as a vet tech, has been away visiting her mother since Brutus started treatment. As easy as the testing is, without someone to distract him, I know he'll quickly figure out my MO and begin becoming resistant. My wife returns late tomorrow, so we'll start getting more and better numbers after that. Second, the vet is saying if we're not seeing any dangerously low numbers with the intermittent testing we're doing now, she won't bless any dosage changes until Saturday, at the earliest. So, I figure I'll spare Brutus the annoyance of collecting too many extra numbers during the period when dosage and timing are pretty well set in stone anyway, especially if he continues to appear quite stable clinically. The high numbers I'm getting when I do test are a bummer (especially for Brutus), but the protocol requires that we start somewhere. Oh well.
 
Riddler said:
My "excuse" for not testing more frequently or with ideal timing is two fold. First, my lovely wife, who actually used to work as a vet tech, has been away visiting her mother since Brutus started treatment. As easy as the testing is, without someone to distract him, I know he'll quickly figure out my MO and begin becoming resistant. My wife returns late tomorrow, so we'll start getting more and better numbers after that. Second, the vet is saying if we're not seeing any dangerously low numbers with the intermittent testing we're doing now, she won't bless any dosage changes until Saturday, at the earliest. So, I figure I'll spare Brutus the annoyance of collecting too many extra numbers during the period when dosage and timing are pretty well set in stone anyway, especially if he continues to appear quite stable clinically. The high numbers I'm getting when I do test are a bummer (especially for Brutus), but the protocol requires that we start somewhere. Oh well.
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How lucky that your wife worked as a vet tech! That will certainly be handy.

As far as what your vet says...not to be unkind...but the odd test here and there cannot keep a kitty safe. All diabetics, including people should test before each shot, since glucose numbers can change even without dose changes. Glucose is not a static entity and fluctuates all day long even in non-diabetics. Eating less food, illness, hot weather conditions, etc etc can affect glucose levels.

A kitty can be high at the morning preshot test and high at the evening preshot test but could very well have dropped down very low in between. When glucose numbers drop too low or too fast the numbers can "bounce" up as the body releases stored glucose (glucogen) in response to rapid drops or numbers dropping lower than the body "thinks" is safe. If you only look at an occasional test it really doesn't give any idea what is happening during the rest of the time. If you aren't catching the nadir (lowest number of the cycle) then the other numbers could look like the insulin needs to be increased, when it may actually need to be decreased.

There are a number of members on here who have had their kitties go into a serious hypo episode while on their usual dose of insulin. If they had not been home testing they would have missed it and a serious hypo can be very costly at the vet ER or even deadly. Testing is so important, both for human diabetics and of course for our furry diabetic "kids"
 
Riddler said:
As easy as the testing is, without someone to distract him, I know he'll quickly figure out my MO and begin becoming resistant.
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Are you giving him a diabetic safe treat after every test? Typically the opposite of this happens--the more tests (and treats) the cat gets, the easier and more willing they are to be tested. Keep in mind that the ear pokes don't hurt them at all, cats have less nerve endings in the tips of their ears than people have in their fingers. It's being restrained, the owner's nervousness, and having something new and strange done to them. Once it's part of a positive routine, they are just fine.

Bandit started out fighting me tooth and claw, and I had more than one bloody hand after my first week testing. Now he comes running when he hears the meter beep on, sits patiently in front of me, and purrs through the whole test. Do not underestimate the power of the treats!
 
Here's something I wrote up for others for testing...maybe it'll help you too!

It can be really helpful to establish a routine with testing. Pick one spot that you want your "testing spot" to be (I like the kitchen counter because it's got good light and it's at a good height....it also already blocked 2 escape routes due to the wall and the backsplash) It can be anywhere though...a rug on the floor, a table, a particular spot on the couch...wherever is good for you.

Take him there as many times a day as you can and just give his ears a quick rub and then he gets a yummy (low carb) treat. Most cats aren't objecting so much with the poking..it's the fooling with their ears they don't like, but once they're desensitized to it and learn to associate a certain place with the treats, they usually start to come when they're called! Or even when they hear us opening the test kit!

You also have to remember...you're not poking him to hurt him...you're testing him to keep him safe and understand what's going on inside his body. There's just nothing better than truly understanding what's going on inside your kitty's body and with this disease, the more knowledge you have, the more power you have against it. The edges of the ears have very few pain receptors, so it really doesn't hurt them. Also, if you're nervous and tense, it's going to make your kitty nervous and tense too. As silly as it might seem, try singing! It forces you to use a different part of your brain!

It's also important to make sure his ear is warm. A small sock filled with a little rice and microwaved or a small pill bottle filled with warm water (check temp against your wrist like you would a baby bottle) works well

For new kitties, using a heavier gauge lancet is also really helpful. A 25-28 gauge lancet pokes a bigger "hole" than a 31-33 gauge lancet does, so look for "Alternate Site testing" lancets that are usually a lower number

Finding the right "treat" will be a great help too! Freeze dried chicken, bonito flakes, little pieces of baked chicken...whatever low carb treat you can find that he really enjoys will help him to associate the testing with the treat! China's Achilles heel was baked chicken, so I'd bake a piece, chop it into bite sized pieces, put some in the refrigerator and freeze the rest to use as needed. It didn't take long for her to come any time I picked up the meter!

There are more testing tips here:

http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

A great video on home testing (but there are LOTS of them on YouTube...once you're there, look on the right and you'll see them...find what works for you!)


Picture of the "sweet spot" we aim for

http://www.felinediabetes.com/FDMB/attachments/sweet-spot-3-jpg.16442/
 
Thanks for the testing tips. As my post indicated, testing hasn't been difficult. Generally doing it pre-shot. Just don't want to risk Brutus getting wise and pushing back until my help arrives, and we can actually use a curve to determine dosage change. My vet insists that absent an obvious clinical problem, that won't happen until Saturday, at the earliest. In the meantime, we're supposed to stick to the 2U BID protocol and monitor enough to avoid issues.

Thanks for all of the helpful advice and encouragement.
 
Riddler said:
we can actually use a curve to determine dosage change
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A curve gives you a snapshot of how things are going on one particular day. If Brutus happens to be bouncing that day, you could erroneously decide kitty needs a smaller dose of insulin. If kitty is running low that day, you could erroneously decide kitty needs an increase.
ETC (edited to correct) If Brutus happens to be bouncing that day, you could erroneously decide kitty needs a larger dose of insulin. If kitty is running lower than usual that day, you could erroneously decide kitty needs a reduction.

Curves are not the best way to determine insulin dosage. Every day is different so while a curve can provide useful information, the best information is that collected over a longer timeframe so that you get a "movie" of how things are going rather than a snapshot. That is why we recommend pre-shot and mid-cycle tests every day.
 
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MrWorfMen's Mom said:
If Brutus happens to be bouncing that day, you could erroneously decide kitty needs a smaller dose of insulin. If kitty is running low that day, you could erroneously decide kitty needs an increase.
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I think you said that backwards? Or I'm reading it wrong (possible...it's been a long day)

If bouncing, it might look like they're too high and need more when actually they need less...without knowing how low the dose is taking them, there's no way to know the right thing to do

Lantus dosing is based on how low it takes them, not the Pre-shot numbers
 
Back to report, with a couple of questions. To summarize, Brutus, a 15 pd DSH, started treatment last Saturday with 2.0 U of Lantus twice a day. His pre-treatment numbers were 300-460 for the couple of weeks his BG was measured, with two fructosamine test results of 540 and 602 one week apart.

Over the last 3 dosage cycles, 5 of the 6 BG readings have been blue numbers (Brutus' spreadsheet is linked below). The 6th reading was a yellow number (298). This morning's pre-shot reading was 110, the lowest to date. Not sure what my vet would say (talked to her yesterday and she told me to stay the course for another 3-7 days), but in light of this latest number (and trend), I reduced this morning's shot by .5, to 1.5 U, just to be safe. Was that the right thing to do? Assuming more blue numbers between now and the pm shot, do I continue to administer 2.0 U, especially if I can't reach my vet to discuss?

Thanks, jr
 
Yes I think that was a good decision to reduce the dose this morning. In the early days, before there is much data, we generally recommend no shot at any reading under 200 but with time as you get to know how insulin is working for your cat, we do shoot lower numbers so no worries. I would however keep an eye on Brutus during this cycle especially between hours 4-8 post shot when the lowest readings normally occur with Lantus. If you can get a reading 3 hours after the shot, it may give you a clue as to how active this cycle is going to be and how much monitoring you need to do. If numbers are dropping by 3 hours post shot, that usually a good clue that it will be an active cycle needing monitoring.
 
It's easier to take more frequent readings on weekend days, so we'll try to gather as much data as we can, especially now that his numbers are almost all in the blue. We're feeding him smaller portions spaced fairly regularly throughout the day, so he basically always has something in him to go along with the activity of the insulin.

The good news is he's back to being himself ((pre-diagnosis). It is interesting though how little water he drinks now with BG well below 240 and the exclusively wet diet he's on (he was 75% dry before).
 
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