Interpretation anyone?

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Nora & John & Tommy

Nora & John & Tommy

Member Since 2010
Hi,

Tommy Walker is a 20 lb Maine Coon, diagnosed 9/19/10, and started on 4u Lantus BID.

Dose was increased by the vet to current levels with minimal BG testing.

Proper diet and monitoring were finally implemented 11/3/10, and we began trying to follow protocols.

11/9/10 through 11/11/10 we tried the Hogdkins approach with Prozinc, but this turned out to be bizarrely unpredictable.

His Lantus chart is here: https://spreadsheets.google.com/ccc?key=t4yRy7w52dmdRchqeRcCaHQ&authkey=CK3I6tcN#gid=0.

We have noticed that a) his dose is relatively high, b) the dose had been increased somewhat quickly and blindly, c) on Prozinc a 2u dose sent BG to the 30's, d) his BG curves seem to run from 24-36 hours, and have no correlation with an insulin curve, and e) the recent increase to 6u seems to have flattened the curve. We were wondering if this looked like a rebound situation? Impatient owners?

Any insights appreciated!
 
Good morning Nora and Tommy Walker! I am so glad to see your post this morning! I hope that the experienced Lantus folks will take a look at his SS and give their thoughts.....

Just wondering what you are feeding him now. Was he just taken off dry food?

Can you take a look at this post in the Tech Support Forum about attaching your SS to your signature? viewtopic.php?f=6&t=18207
Good job with creating the SS but if you can attach it to your signature, it will automatically come up each time you post. We do need to see the link to keep up with your BGs....good job!

There are starred stickies at the top of the page that contain important information for you. please read "New to the Group" viewtopic.php?f=9&t=18139 And post any questions you may have. We suggest that you have canned foods with gravy that are High Carb >18% available at all times, as well as karo syrup. Have your referred to the Janet & Binky Food chart? http://binkyspage.tripod.com/canfood.html

Welcome again! I hope that you will be able to post a new condo(thread) each day so we can watch Tommy Walker's progress!
 
Your current dose is 6u BID with Lantus? That dose is VERY high in such a short time.

What are you currently feeding the cat? What do you mean by proper diet? If all dry then I can understand such a high dose giving higher numbers.
Take away the dry and high carb food, even wet high carb food like the gravy and grilled types, and you will see the BG numbers drop and you won't need such a high dose.
Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

I don't know about the others, but it may be an idea to cut that dose down and start over, following the protocol:
Tight Regulation Protocol
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED
Lantus&Levemir – Data Ready to Shoot Low Numbers

There may well be a reason for the need of such a high dose if there is insulin resistance as my two have, but first you need to make sure you did not pole vault right over the right dose.

Welcome to the site. Be sure to ask all questions you may have; someone will have a reply for you.
 
Thank you Pat, Raja and Shadow for the welcome and encouragement.

Tommy eats Evo and Purina DM canned, about 1-3/4 cans (5.5 oz) per day total. The vet provided the quantity. As of 10/31/10, hi-carb and dry food is no longer on the menu.

We have karo, and will pick up something hi-carb w/ gravy. Any suggestion?

Gayle, the possibility that we "pole-vaulted" is one of our concerns. Insulin was started two months ago at 4u BID, and increased to 5, 6, and then 7 by the vet, based on one or two BG readings, no curves. When we eliminated dry and hi-carb food, we dropped his dose based on what we read here. Dropping the dose was contrary to the wishes of the vet, and the vet recently dropped us! This was probably for the best, and we have an interview with a new vet this afternoon.

Starting over using the Lantus protocol is very tempting, but our concern is that he has had high BG's for some time, and has developed neuropathy. What if he actually needs all this insulin, and starting over means continued high BG's, and possibly ketones?

How is a decision made under these circumstances?

We really appreciate your time and responses.
 
There is some sort of formula vets use to initiate their doses - so much insulin per kg. body weight - I'll look for it, that may be why they started him so high, he's a big boy.

new vet interview - very best wishes - there are several articles on the boards that were written by vets, might be good if you printed some out to take with you when you go, so he can see where you're coming from.

sorry the old vet dropped you, you aren't the first one that's happened to.

our vet clipped our dose up pretty high before Shadow and I found this place and ultimately, we cut her dose in half and in effect, started over. her dose still went up from there but at least I wasn't concerned that we had leap-frogged over her ideal dose and now she is on MUCH less insulin per day.

HC food - anything with gravy, there is Gravy Lover's Fancy Feast, my favorite is Friskies' Prime Fillets Chicken and Tuna, I've done the beef Prime Fillet too. (Thanks Pat + Raja + Shadow for that hint). TONS of gravy in that can and quite economical.

Do you test for ketones at home? If not, you can pick up some ketostix when you go out for your HC cat food. someone here will tell you some "cheats" to test their urine - sometimes you have to get creative. :-D

nice to meet you Nora and Tommy Walker. good luck with the vet today. come back this evening and tell us how it went, k?

eta: oh, hey, good job on the SS. you might want to print that out too, and take with. it will show the new guy how committed you are to getting Tommy Walker back to good health.
 
Hello and welcome,

Has Tommy ever had ketones? Was he diagnosed with DKA? You can get ketodiastix at the pharmacy, which you dip into his urine to test for ketones.

I hope those with more dosing experience can come and help. When I was new here, many concerned Lantus users wanted me to drop my dose too, and I was very reluctant to do so. In the vast majority of cats with higher doses, they have skipped over the 'right' dose and need to start over.

My best advice is to read the stickies, then read them again.

Best of luck to you and Tommy Walker!
 
I was going to suggest you test for ketones and I see that everyone beat me to that. This is quite important, so please do get the ketone sticks at the pharmacy and try to get a reading. I put Shadow in the bathroom and closed the door. I did need to give him some tuna water, but eventually he did use the litter box and I was able to get a test. From then on, I was able to get a sample in a cup when he went, but he wasn't upset when I approached him. so, that was easy form then on for me.
We put saran wrap over the LB in hopes that they will use the box and then we will be able to get a sample.

Hoping that your new vet will work with you. I actually was prescribed a high dose (4.0u for Shadow and 3.0u for Raja) and when I found this forum and began home testing, I lowered their doses and began all over again without the vet's assistance. With the neuropathy and other concerns, it would be good if we wait for some of the more experienced people her to stop by and take a look at his SS, okay?

I would suggest printing the Protocol shown in the tight regulation sticky.
viewtopic.php?f=9&t=1581 It is what we follow here and it would be good to get feedback form your new vet on this. Many vets do believe in high doses though....and I have found it better to just go to my vet for the check ups and whatnot but to decide on my daily dosing approach by following the Protocol here and the experienced people on this forum. It is up to you though...I wish you well today...
 
Hi and welcome...

Just some suggestions about testing for ketones - someone told me that you can take a bit of your cat litter (clean) and mix it with a bit of water. Then, test with the ketostix - if it comes back negative, then you know it's neutral or whatever. I used to just stick the ketostix in a clump of fresh(ish) urine in her litter box to test, since trying to catch urine was not a likely possibility (unless we were at a vet's office!).
 
Testing for ketones is VERY important. You don't want to be doing the starting over thing if you have any ketone issues.

If there are no ketone issues, starting over can be done easily. when I adopted Oliver, I had no real idea of what his dose should be so even though he had very high numbers, I started over.
If you look at the start of his ss, you will see how his dosing changed.

If you have ruled out any dangers of ketones, etc, that would discourage starting over, you can just follow the protocol - start at a lower dose (others can say what it should be, but 1u is typical), hold for 5 days, and then with the data collected, start your increases of .5u or .25u, based on the nadirs you have received. Each new dose would be held for at least 4-6 cycles (2-3 days), then adjust again.
It will be clear by your test numbers how the dose is doing. By starting over, you will rule out any doubt about missing the fitting dose and so you are having constant high numbers.
The waits are necessary because you need to have the shed filled, topped up, before you will see how a dose is working.
I am now giving Oliver almost 19u BID, but his insulin resistance is his problem. By my starting over in the beginning when he arrived, I did not doubt his numbers.

Ketones, dental, diet and other issues need to be ruled out first. If ketones are present, I have no experience on that problem, but many others here will be able to help you and suggest how to proceed.

Like Pat, my vet gives absolutely NO input on my dosing, but the vet is more for reg health issues, like infections and dental and meds. I keep them up-to-date with copies of their spreadsheets on each visit, but that's about it. They admit that I know more about FD than they do, but it's all due to the people on this site.
 
Welcome! It would be very helpful if you could put in the data you have from when you switched to ProZinc...just put it in the blank areas you left and make a note that it was ProZinc. It helps to have all of the data.

I see others have already asked about ketones, so I won't repeat what has already been said. If you need help testing, please let us know. It is important to know if ketones are involved.

This is a pretty high dose, but some cats need a high dose. What is concerning to me is the way it was arrived at (little to no testing) and the way the numbers are all over the place since you have begun testing. If you were to re-start at a lower dose, and it turned out that he needs to get all of this insulin, then he would end up back up at this dose. But at least then you would know that he needs this much insulin. I suspect from what I see on his SS that he is overdosed.

I understand your concerns about continuing high BG, neuropathy, and ketones. But he already has continuing high BG and neuropathy with what you are doing now, plus he is bouncing all over the place and that can't feel good. If you were to cut the dose and work your way back up gradually, you would probably get him feeling better more quickly and certainly more safely. As far as ketones, that is an important issue..please let us know if he has a history of ketones as that will certainly make a difference.

As far as the dose, I would like to see the ProZinc data and find out about his ketone status before discussing any specific dose. Hopefully others will also weigh in.

Good luck with the new vet...please let us know what happens there!
 
Thanks to all for the helpful input.

The new vet seems supportive of home treatment, so that's a good thing! He'll take care of prescriptions and normal care, and we'll keep him updated.

To the "ketone kops" :-D : We have not tested for ketones, and Tommy has no history of DKA. We will pick up test strips today and begin testing. Have read the articles, but still not sure about what to do if positive? Does a positive test mean an automatic call to the vet?

It makes sense that restarting at a low dose - with ketone testing - would be a safe way to prove whether we "leap-frogged" past the correct dose. We would appreciate recommendations for appropriate starting dose. The original 4u starting dose from the vet does agree with the Lantus protocol (.25u per kg), but it appears that many folks here start at 1u. As mentioned, Tommy is a big 'un at 20 lbs.

The SS has been updated to show the Prozinc experience. It made no sense at the time, but could possibly be explained if the first 2u dose (which was recommended by the vet, and was half of the dose on the Hodgkins scale) was too much, and caused rebound?

Thanks again for being willing to share your experience and let us "talk this out".
 
The only thing I would add is the Purina DM is not a good food choice (sorry). It's actually higher in %calories from carbs and I don't know of anyone in Lantus group that has been here a while that feeds it. So take a look at Janet and Binky's food charts. You'll have to learn what he responds to in terms of % calories from carbs; my Gracie really needs to stay under 4%. The caveat is you need to work with your vet (who sounds great) and or this group on slowly transitioning him because if you lower the dose of lantus AND lower the higher carb foods, it might possibly cause his BG to drop too much. The canned Evo 96% beef is 4% calories from carbs and the canned Evo 96% chicken (turkey with it maybe?) is 2% calories from carbs so those Evos are generally a good choice if he likes them. Again, you want to change slowly and not just stop him on the Purina DM. Some of the more experienced folks here can discuss that further with you but just wanted to put the thought in your head. Welcome to LL!!!
 
Welcome to LL, Nora. The only suggestion I have is to get some methylcobalamine (B12) for Tommy. It could help with the neuropathy. Starting over is scary, but I agree with the others that Tommy may be getting too much insulin. And if you are getting high nadirs after you've started over, you can move up the dosing scale pretty quickly. I hope all of this helps. :-D
 
Welcome to lantus land...Your vet did you a favor by letting you go, as the new one I'm sure will be so much better- I had one of those vets & found a real good one now
You have received a lot of info today.
We have a wealth of info for you here and many many people to help. Moonie also has neuropathy, regulation & methylcolobalamin has helped a great deal.
Here's the link to Janet & Binky's food lists-Hope they help

http://www.felinediabetes.com/diabetic-cat-diets.htm
 
Thank you for adding in the ProZinc data, that helps. I'm glad to hear that your new vet is supportive!

I know we sound like a broken record on the ketones, but it is important. Please let us know what the results are when you get a test. If you get anything above a trace, you need to go to the vet. Even trace ketones are concerning and need action to deal with them. I don't have personal experience with them, but others here do and can give you more info.

On dosing....I'm not sure where you figured that 4.0u would be the starting dose by weight...if you use the weight formula, it would be 2.25u. There is a calculator in the "New to the Group" stickie. However, when the cat has been on another insulin, the dose of the other insulin can be taken into consideration when deciding a starting dose. Looking at the ProZinc data, it is apparent that the 2.0u dose that he was given was too high...he dropped too low on it. Even a tiny dose (0.25u) gave him a good sized drop. (And yes, the big rise after the 2.0u dose was a bounce/rebound from too high of a dose.) So, that indicates that even 2.0u is too high of a starting dose to me. Some people do start at 1.0u, so you could do that, but I think that 1.5u would be a reasonable middle ground. So that would be my suggestion, 1.5u.

If the ketone test shows positive results, that would change my suggestion, but you could start there and increase if need be due to ketones.

If his numbers stay high and flat, there is leeway in the protocol to increase dose more aggressively, but generally we suggest staying at the starting dose for 5-7 days.

Hopefully others will chime in with their suggestions too.
 
Welcome to Lantus Land!

You've already made a great start by having your spreadsheet up and running. You've gotten some great suggestions already.
  • Food - Purina DM isn't horrible. It's 7% carb. We consider low carb (LC) to be below 10% carb. Many of us feed substantially lower than 10%. The bigger issue with DM is that it's a very poor quality food. For what you're paying for a prescription food, you can buy a premium quality cat food (e.g., Wellness or EVO) that is primarily muscle meat vs. animal by-products. Many cats really don't like DM, either.
  • Neuropathy - methyl-B12 is a good remedy for dealing with diabetic neuropathy both for humans and cats! This product does not have sugar or flavorings. You add a capsule to food (or divide it up over each meal of the day.) Methyl-B12 is water soluble so whatever isn't metabolized is excreted.
  • Dose - I agree with what Laurie has suggested. From the way we work up to a dose, you haven't had a protocol to guide your dosing decisions. I'm not sure what your old vet was using to guide dosing, but based on your experience with another insulin, it would see to make sense to start at a level of insulin where you were getting some good results and we can tweek the dose from there.
 
Hey Nora - have we overloaded you? :-D you sound like you have already done a great deal of reading, good for you. knowledge is empowering.

Shadow loved DM - our vet sold it to us for a while before I found this group. She ate well and did OK on it. But once I had been here a while, I learned that it is a bit expensive for what you get. One of the things our kitties need are good quality proteins and DM just doesn't offer that. For the same price, Tommy Walker could be eating the posh high-quality stuff. There is a decent over-the-counter cat food choice for every budget without having to pay for DM.

Before you go shopping for B12 for Tommy Walker, read up on what sort to shop for. There is a certain kind that is recommended. Some folks here mail-order theirs. I have a very good selection at my local health food store. Sienne has given you a link to one that many folks here are very happy with.

Sienne and Gabby said:
Dose - I agree with what Laurie has suggested. From the way we work up to a dose, you haven't had a protocol to guide your dosing decisions. I'm not sure what your old vet was using to guide dosing, but based on your experience with another insulin, it would see to make sense to start at a level of insulin where you were getting some good results and we can tweek the dose from there.
Click to expand...

very sound advice. You can back-track a little on your dose without competely starting over at square one. and as long as our boy isn't spilling ketones, then you have lee-way to work on finding his good dose.

sleep on it, read and read and read some more and come back with every question. these folks here are so patient and knowlegeable and kind and they want the best for you and Tommy Walker.

good luck guys, we'll be looking for you around the boards.
 
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