is this a bounce?

[Lkldcatlady]

I'm going to pull every hair on my head out. Could someone please take a look at Bob's numbers and tell me what the heck is going on??? I'm very careful with his insulin and I always make sure he didn't get a fur shot, so I can't understand why his numbers are so goofy. Yesterday, he started on 2.75 units. so by 6 hours, his numbers were slight up????? then this morning, it's the highest it's every been. Now, admittedly, I did not check in the middle of last night, but could it have gone down enough to cause a bounce maybe? I did read that a bounce can be caused by a number that is not necessarily low by our standards, but for the cat's body, it may be low enough to cause a bounce (even if its in the 200's). Is that true? Also, since I was on 2.5 for a week and didn't get any good numbers, obviously going to 2.75 was the correct thing to do. So, do you just ride out the bouncing, if it is bouncing (I think i saw a post that said it usually clears itself in 72 hours). This is such a frustrating experience. It's been exactly two months and my poor cat has hardly had any good numbers at all. How long will this take????? It makes me sick that his numbers are staying so high.

 

[Wendy&Tiggy(GA)]

could it have gone down enough to cause a bounce maybe? I did read that a bounce can be caused by a number that is not necessarily low by our standards, but for the cat's body, it may be low enough to cause a bounce (even if its in the 200's). Is that true?

Yes, a bounce can be triggered when the cat drops lower than it is used to , or if it drops too fast.

It looks to me like something is keeping Bobs numbers high ....remind me, is this Purina DM wet or dry? i am hoping you made the move to wet as dry isnt helping at all.

Wendy

 

[Deb & Wink]

I'm going to pull every hair on my head out. Could someone please take a look at Bob's numbers and tell me what the heck is going on???

Oh no! Dara will be bald soon if we can't get those numbers into a better range. :shock: We want you to keep those lovely locks of yours intact so lets see what we can do.

First, take several deep breaths and let them out. I can tell you are really frustrated and we need to get that stress level down. Chocolate? glass of wine? Should I loan you a beautiful pair of patience pants or will just want to throw something at the screen when you see them? ;-)

I'm very careful with his insulin and I always make sure he didn't get a fur shot, so I can't understand why his numbers are so goofy. Yesterday, he started on 2.75 units. so by 6 hours, his numbers were slight up????? then this morning, it's the highest it's every been. Now, admittedly, I did not check in the middle of last night, but could it have gone down enough to cause a bounce maybe? I did read that a bounce can be caused by a number that is not necessarily low by our standards, but for the cat's body, it may be low enough to cause a bounce (even if its in the 200's). Is that true? Also, since I was on 2.5 for a week and didn't get any good numbers, obviously going to 2.75 was the correct thing to do. So, do you just ride out the bouncing, if it is bouncing (I think i saw a post that said it usually clears itself in 72 hours). This is such a frustrating experience. It's been exactly two months and my poor cat has hardly had any good numbers at all. How long will this take????? It makes me sick that his numbers are staying so high.

Could be NDW (new dose wonkiness). Yes we have not only a term for it but an abbreviation as well. ohmygod_smile

There is an explanation of NDW from over in Lantus TR but not always easy to find so I will quote it here:

The Tight Regulation Protocol with Lantus or Levemir describes what we've fondly dubbed "New Dose Wonkiness" (NDW) here in LL:

"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."

The concept of "New Dose Wonkiness" is NOT applied to higher numbers which may be seen after a dose reduction.

There is no "NDW" following a dose reduction nor do we hold a reduced dose 6 cycles (as done with dose increases) to "fill the insulin depot".
"Settling time" does not apply to dose reductions. We don't wait for a reduction to "settle".

When you see numbers trending higher after a dose reduction we immediately return to the last "good" dose as described in the The Tight Regulation Protocol with Lantus or Levemir:

"If the cat will not stay in the normal range after a reduction, immediately increase the dose again to the last good dose."


Hope this helps...

Could be a bounce. From the same topic, more of an explanation of NDW and bouncing.

when you increase a dose of lantus, you would expect the BG numbers to go lower, right? that's logical. more insulin = lower numbers. only there is a lag time sometimes - increase the dose and for some reason the numbers go higher. that can last a day or so, and then suddenly you start seeing those lower numbers you expected. we call those higher numbers "New Dose Wonkiness" or NDW.

this is the reason we wait following each dose increase to let it settle and see what it's really doing.

now not every cat does that, of course. ECID. sometimes you increase the dose and you immediately see lower numbers. the point of this post is to say that IF you increase a dose AND you see higher numbers, give it a couple of days for things to settle down and then you can assess the dose to see what it's really doing.

the second part of the post is saying that this doesn't apply to a cat when you DECREASE a dose. let's say mookie drops below 50 today and you decrease the dose. if you see higher numbers following the dose decrease, that's not NDW. NDW only applies when you're increasing a dose. higher numbers following a dose decrease can be from one of two things. one possibility is that it simply isn't enough insulin. another possibility is if the cat dropped quickly, or if the cat dropped into a lower range of numbers than it was used to, that can cause a bounce.

BOUNCING

Here is an example of a bounce from someone's recent condo:

you can spot a bounce this way (this only took me 6 months to learn and a bunch of people explaining it! i'm a slow learner!)

yesterday morning you had a 215 - then it went 235, 271, 270, and then 308 this morning - basically straight up. no curve. and then look backwards in the ss and the night before was that sweet little 148 12 hours earlier.

if you imagine that night-time cycle, starting at 148, kitty probably went down in a nice little curve, hitting something under 100 mid-cycle. that lower-than-usual number would've shocked her body. they get accustomed to whatever range they're in, and any sudden dip lower can set this off.

"HELLO WE"VE GOT A 911 HERE- KITTY'S GOING DOWN!" yells Mr. Liver. Fortunately, mr liver has a storehouse of counter-regulatory hormones and stored sugar (in case kitty needs a little nommy sweets in the middle of the night) and when Kitty gets into a range of numbers lower than usual, Mr. Liver lets loose with the sugar and the hormones and sends Kitty on a rocket to the moon. this is the cat's body's protective mechanism to keep the cat from becoming hypoglycemic. unfortunately, mr liver doesn't seem to know that anything above 40ish isn't a crisis and it will do this regardless of the range of numbers, even at 200 if the cat has become accustomed to 400.

A second cause of a bounce is if a cat drops very quickly. 100 points in an hour, for example, regardless of the range the BG number is in, can cause a bounce as well.

So, what to do now? don't increase the dose because of these higher numbers. once this bounce clears, which can take up to 3 days of high numbers if mr liver is super-active, then if you had increased the dose, it would be too high. you are entering the phase of treatment that we say requires "Patience Pants." when you think you're seeing a bounce, you have to wait it out, then you can see what the dose really does. You will know the bounce has cleared when you start seeing numbers you were seeing before - like that 148 again.

edited for clarity.

 

[Lkldcatlady]

Yes - please loan me some of those patience pants (and maybe a wig)!!! :lol: I will definitely read all your information. Thank you!

It just seems like a lot of people get their kitties regulated much faster. It may definitely be related to the food, but I can't switch Bob right now. The specialist I took him to in Brandon said he has enlarged lymph nodes down by his small intestines. She said it's not something to be concerned about right now, but it could be lower bowel disease or something else she mentioned that I don't remember. Anyway, she said cats with those issues tend to be very picky and maybe that's why Bob is so ultra picky about his food. I've really tried everything possible at this time, but he will not eat anythign but tuna and even then, he licks it dry and leaves it sitting there. I work a full time job and a couple of part-time jobs (in order to support my three kitties and all their health problems) and I absolutely cannot leave home after injecting him with insulin and not knowing that he ate a decent amount of food. I've talked at length with the specailist and my vet and both have regulated cats on dry food and even gotten some into remission. I'm definitely not arguing that wet food is better - I completely agree. The specialist (who i don't agree with about everything) says right now it's more important that he eats regulargly, preferably with what is considered a lower- carb food (under 20%) and I do agree with her on that. So, at this time, I'm just trying to understand what's going on with his numbers.

 

[Deb & Wink]

Dara,

I always hate to ask people to do this, but would you be willing to set your alarm for a couple of tests at night?

A few at mid cycle, around +5 to +7 timeframe would be helpful. I know it can be really, really hard for some people to get back to sleep if they get up in the middle of the night. Maybe if you have to get up to use the bathroom, grab a test on Bob before you go BTB?

We don't need you to do this long term, but a couple of nights in a row might tell us if Bob is dropping low at night and then shooting low in the morning.

One other thought I had was to check to see if the insulin was still good. Is the insulin still clear? Check it for floating particles or cloudiness. Lantus should be clear with no particles. Not left out in the warm temperatures down there in Florida? Protected from light?

I'm posting over in ISG Lantus TR to get some more ideas for you. The more the merrier as they say and maybe someone will have another idea. Can't hurt.

 

[Lkldcatlady]

I can definitely get some numbers on Bob tonight. I'll set my alarm - I don't have too much trouble going back to sleep. I just hate waking him up to do that, but it's for his own good!! So get 3 numbers - at +5, +6 and +7?

The NDW was helpful. Maybe that's what is going on. I think my vet did a really bad job with the Prozinc, raising it so fast and we just never got it right. I just thought the Lantus would help faster, but maybe it will just take some time.

I haven't had the lantus very long, but it still looks clear and I'm really careful with it - no leaving it out, no shaking or rolling, etc. I didn't see any floaties last night when I looked (and i specificially looked for them.)

BTW, I'm taking Bob for a fructosamine test on Thursday and an exam by the specialist. I really like her but she aggravates me because she doesn't think I should test Bob at home. She says "only test if he's acting different". Well, how easy is that to do when I'm at work or sleeping during his lowest numbers?? She's trying to tell me that it raises his blood sugar when he's stressed and by me testing all day, I could be stressing him out. He's really laid back and usually just lies there and purrs, but every now and then he will try to pull his ear away. Do you think there is anything to what she is saying?

 

[Dyana]

You don't really need to pay for a fructosamine test as you have all the numbers in your spreadsheet to see what his BGs have been.
Vets are not used to people being so proactive and home testing like we do, so they don't understand that the testing is not bothering them (especially when they get a treat or some loving afterwards).

When you test next is partially based on his last test numbers. If his PMPS is high, then get a before bed test at around +2 or +3, and as long as those numbers are still high or about the same, then try to get a mid-cycle test say at around +6. If his PMPS is lower like in the 200s and his +2 or +3 is even lower like a 150, then you might want to squeeze in an additional test at +4 or +5 again dependant upon the last test numbers.

 

[Deb & Wink]

I can definitely get some numbers on Bob tonight. I'll set my alarm - I don't have too much trouble going back to sleep. I just hate waking him up to do that, but it's for his own good!! So get 3 numbers - at +5, +6 and +7?
Good! Those times sound good for tonight. Might want to try something different for tomorrow night if you are willing.

I'm always afraid to ask someone to set their alarm for those mid-cycle tests at night but sometimes you have to do that to figure out what is going on. I never know how much of a burden this is on someone or how busy their life is, when they get up for work, crying baby kept them up all night the night before, or other complicating factors. Chronic insomnia can affect people and getting up in the middle of the night can make it worse for days. Myself, the chronic insomnia was another opportunity to test Wink when he was still receiving insulin and an opportunity to see what was going on. It all depends on your perspective. ;-)

I really like her but she aggravates me because she doesn't think I should test Bob at home. She says "only test if he's acting different". Well, how easy is that to do when I'm at work or sleeping during his lowest numbers?? She's trying to tell me that it raises his blood sugar when he's stressed and by me testing all day, I could be stressing him out. He's really laid back and usually just lies there and purrs, but every now and then he will try to pull his ear away. Do you think there is anything to what she is saying?

You would not be the first or the last caregiver to disagree with their vet on the hometesting. Cats can get stressed from BG testing, especially in an unfamiliar environment. Most cats can't even stand the car ride to the vet clinic, let alone being surrounded by all those strange people and DOGS!!! Everything I have seen, suggests blood testing at home because that is a less stressful environment, more familiar to your cat.

AAHA Guidelines has this to say. The bold is mine to highlight what they say about home monitoring and why. Ongoing Monitoring of the Cat

Monitoring strategies may be influenced by persistence or resolution of clinical signs. The pressing concern for the newly diagnosed and treated cat is the development of hypoglycemia in individuals that may quickly go into remission.[b] Cats on long-acting insulin may not show overt signs of hypoglycemia until the BG is dangerously low, so it is important to identify impending hypoglycemia by home glucose testing whenever possible.[/b]If BG monitoring is not possible, close attention and documenting changes in clinical signs are imperative. Likewise, urine glucose testing using glucose-detecting crystals in the litter can be helpful for detecting diabetic remission.17

[b]Ongoing home monitoring for all cats[/b]
Log food, water, and appetite daily.
Log insulin dose daily.
Note any signs suggestive of hypoglycemia; contact veterinarian if persistent.
Periodically test urine, looking for negative glycosuria (suggestive of hypoglycemia or diabetic remission) or positive ketonuria (suggestive of substantial hyperglycemia).

At 1 week after initiating insulin treatment
If clinical signs have improved, and no ketonuria is present: Continue present insulin dose.
[b]Introduce home monitoring if not already done.[/b]
If a spot check on the BG is possible, assess for hypoglycemia at 6 to 8 hours following insulin administration
If BG is <150 mg/dL, either decrease insulin dose to 0.5 U q 12 hours, consider dosing q 24 hours, or suspend insulin treatment and wait for clinical signs and glycosuria to recur before restarting insulin at 0.5 U q 12 hours.

If clinical signs have persisted or worsened: Evaluate client compliance and dosing technique (see Client Education).
If adherence is good, consider increasing the dose to 2 U q 12 hours.
If the cat is ketonuric, has developed peripheral neuropathy, or does not have a good appetite, evaluate for DKA and rule out complicating disease (e.g., pancreatitis) that may be worsening the diabetic state.

During the first month after initiating insulin treatment

In-clinic (only if home monitoring is not possible)

Every 1 to 2 weeks:
Spot checks of BG at 6 to 8 hours following insulin administration. Decrease insulin dose if BG is <150 mg/dL.
Cautiously increase insulin dose if clinical signs persist or worsen or ketonuria is noted. Do not exceed 3 U per injection.

Urinalysis (to detect glycosuria, ketonuria, or infection).
Consider BGC if clinical signs persist or worsen and insulin dose is at 3 U per injection.

[b]Home[/b]

Weekly:
[b]Spot checks of BG at 6 to 8 hours following insulin administration (more often if hypoglycemia is suspected).[/b]
Increase dose if necessary based on BG results.
Urine dipsticks for glucose and ketones (particularly useful if BG measurements are not possible).

Every 2 weeks:
[b]Perform BGC (see protocol for BGC).[/b]
Utilize urine dipstick or litter glucose-detecting crystals.
Adjust insulin as discussed previously.
Consider insulin overdose and/or possible diabetic remission if three consecutive negative urine glucose results are obtained.
If ketones or persistently high urine glucose are noted, a clinic evaluation is in order; consider the need for dose increase.

At 1 month after initiating insulin treatment
In-clinic examination recommended for all cats: Thorough history, physical examination, weight, and urinalysis.
[b]Measure fructosamine [size=5]unless detailed home-monitoring records are available[/size].[/b]
Additional laboratory analysis if indicated by examination [Table 1].
Adjust insulin if needed; insulin dose should not be increased more than 1 unit at a time
The cat must be reevaluated if clinical signs persist at 3 U q 12 hours. Consider problems with insulin duration or action, concurrent conditions, or medications causing insulin resistance. The majority of cats on insulin glargine or PZI do not need >3 U of insulin q 12 hours to control diabetes.


Long-term monitoring of insulin treatment

Advise clients to monitor and record the following:
Daily: Clinical signs, food/water intake, insulin dose.
Weekly: Body weight.
Monthly: [b]BG spot checks (twice monthly if practical). If on insulin glargine, evaluate BG prior to insulin administration and at 8 hours following.
If on PZI, evaluate BG prior to insulin administration and 3, 6, and 9 hours later. [/b]Twice monthly: Urine glucose and ketones. If urine glucose is consistently negative, consider diabetic remission.

In-clinic:
Any items listed above that client cannot perform.
If the cat is doing well, [b]don't make changes based on increased BG measurements alone, especially if measured at the clinic.[/b]
Every 3 months: Examination, including weight.
Every 3 to 6 months: Serum fructosamine concentration. If at the lower end of the reference range or below the reference range, consider chronic hypoglycemia and diabetic remission.
[b]Consider monitoring BG or urine glucose at home[/b], or decrease insulin dose and recheck in 4 weeks.
If BG is consistently <150 mg/dL or urine is persistently negative for glucose, or both, consider decreasing the insulin dose, switching treatment to q 24 hours, or stopping insulin and monitoring response. In cats, glucose toxicity suppresses beta cell function, and with control of hyperglycemia and resolution of glucose toxicity, the remaining beta cells become functional again and start secreting insulin.
Every 6 to 12 months: Full laboratory analysis [Table 1].


I was really lucky with Wink. Vet is only 5 minutes away and he is one laid back dude at the vets.

Maybe print out a copy of the guidelines to politely share with your vet as to why you want to continue to home test. You may end up simply agreeing to disagree on the value of home testing. It may start a seed to grow in your vets mind and that could be a good thing for the next diabetic client.

BTW, I'm taking Bob for a fructosamine test on Thursday and an exam by the specialist.

Why is your vet doing a fructosamine test when you have more accurate real time numbers from home testing? Take a copy of your SS with you or email it to her. If you look at the AAHA Diabetes management guidelines again, they say

At 1 month after initiating insulin treatment
In-clinic examination recommended for all cats
Measure fructosamine unless detailed home-monitoring records are available

Just an option to think about and possibly save a little bit of money. Your choice as always.

 

[Wendy&Neko]

I agree with Dyana that you can be strategic about when you get up in the middle of the night. If there is a good drop from the PS to the +2 or +3, then that's a good time to get up for that mid cycle test. My Neko could easily hit below 100 if she started over 400 PS and earned her first deduction in a cycle she started at 412. Bob's liver probably isn't used to much yellow, much less blues or greens. Cat's will bounce when they see numbers they aren't used to and looking at last night, there's a good chance he saw at least yellow.

 

[Lkldcatlady]

Thanks guys-that's alot of good info. The reason I'm taking him for the test is because she wants to examine him anyway. I kind of feel like she is irritated that I insist on home testing. She's a good dr. And I want to continue to see her, especially if I can't get him regulated and need to figure out why. I will take a copy of these guidelines to her. I kind of want to see what the fructosemine test shows and I really hope I have the same average on my alphatrak so I can show her. Well, bobs pmps was 380 and +3 was 345. Ill check his +6 and +8. Thanks again.

 

[Lkldcatlady]

I don't get it, I just don't get it. I read some of these posts and people are giving their cats .5 (or less!) units of Lantus and the cat is regulated. WHY is Bob's pancreas being so stubborn????? It's only been one day, but every time I see those high numbers, I get so upset. :cry: I have ripped out the seat of my patience pants and my hair is next!!! why in the world would bob's numbers at +6 be higher than his pmps? And he eats EXACTLY the same way at 7:00am and 7:00pm (1/3 cup and food is gone by 2-3 hours) so why would his pmps be 380 but his amps be 500??? I'm ready to throw myself on the train tracks but I don't know who would take care of my boo if something happened to me, so I'll try to hold on! ohmygod_smile

 

[Libby and Lucy]

I don't get it, I just don't get it. I read some of these posts and people are giving their cats .5 (or less!) units of Lantus and the cat is regulated. WHY is Bob's pancreas being so stubborn????? It's only been one day, but every time I see those high numbers, I get so upset. :cry: I have ripped out the seat of my patience pants and my hair is next!!! why in the world would bob's numbers at +6 be higher than his pmps? And he eats EXACTLY the same way at 7:00am and 7:00pm (1/3 cup and food is gone by 2-3 hours) so why would his pmps be 380 but his amps be 500??? I'm ready to throw myself on the train tracks but I don't know who would take care of my boo if something happened to me, so I'll try to hold on! ohmygod_smile

ok, no throwing yourself on the train track. ;-)

First, ECID (Every Cat is Different) is not just a saying. It's true. I have been here over 5 years and until recently had studied almost every Lantus spreadsheet here. Boy, is every cat different. :mrgreen: Look at the spreadsheets of my three diabetic cats, in my signature. Jazzy had acromegaly, so hers is very different. Lucy climbed up to 4.25 units, then earned some reductions, then climbed to 4.25 units again, then finally went OTJ. KK arrived here on 5 units BID of PZI, I switched him to Levemir at 1 unit, up to 2.5, and now he is working his way down. There are plenty of Lantus and Levemir cats on doses of 3-4 units, it's actually more common than doses of 0.5 units unless the cat is already on his/her way down the dosing scale. So breathe!

To add a different perspective to those that have already been expressed, here is what I see happening on the Lantus part of your spreadsheet. I see that you reduced the dose a bit when you switched to Lantus, which is good. I think 2 units was a logical starting point, based on the response Bob was seeing on 4-5 units of Prozinc. Numbers weren't so good, so you increased to 3 units on the vet's advice. Not terrible. I would have increased, but probably by 0.5 unit rather than 1 unit, but it's not that bad. Then he got down to green on 3 units. Great! You reduced the dose, which is understandable. Reducing by a whole unit is kind of a big reduction, and it looks like Bob lost momentum at that point. This happens ALL the time - look again at my Lucy's spreadsheet - several times I took reductions that did not hold. The best thing to do once a reduction fails is to increase the dose again, according to protocol. You did that, you held the 2 units for 6 cycles and then increased again. That is exactly what I would have done. Given that the numbers are still high and not getting lower than pink, you can keep increasing every 6 cycles until you start seeing some movement. It is not uncommon, in this situation where they lose momentum, to end up needing to go a little higher than the dose that caused the original breakthrough. It's ok, you just give him the amount of insulin he needs and he will find another breakthrough dose. It might be 3 units again, or it might be something else, but it will probably be in that neighborhood somewhere.

What I'm saying is that Bob is not weird, and you are doing a good job with him. Don't worry about what other cats are doing. Some cats come in and almost immediately go off insulin after a few shots of a small dose of insulin. Others take their time.

Another thing I've learned about Lantus, and I won't go into too much detail yet to avoid overwhelming you, is that it really doesn't pay to look at each cycle on its own. Lantus tends to work in "waves" of action. You will learn to lean back and squint at your spreadsheet so you don't see all the individual numbers, but "waves" of colors going over 2-3 days. Sometimes the mid cycle numbers will be higher than the preshots, but it fits into a bigger pattern somewhere. Nothing to worry about. :smile:

 

[Lkldcatlady]

What I'm saying is that Bob is not weird, and you are doing a good job with him. Don't worry about what other cats are doing. Some cats come in and almost immediately go off insulin after a few shots of a small dose of insulin. Others take their time.

Thanks so much! I needed to hear that! Someone on the Lantus board told me since Bob has not gone below 300, I should go ahead and start increasing him .5 units every 6 cycles so I think I will do that. And I'll stay away from the train tracks! It would just be nice to see some colors other than pink and red on his sheet!

 

[Deb & Wink]

I'm ready to throw myself on the train tracks

Sorry, no train tracks in your future. Not if we have any say in the matter. Although, there is a nice set of train tracks a couple hundred yards behind my house. You'd have to bring Bob up to MA to use them though. ;-)

Yes - please loan me some of those patience pants (and maybe a wig)

No wigs in your future either.

Ok, Dara, I want you to take 5 or 6 deep breaths before you read the rest of what I have to say because I want you calmer and clear headed so you understand. You may want to read through once and then go back and reread.

I know how upset you are and frustrated. Been there. Yes, looking at other cats SS's and reading through other posts, makes you wish Bob could be like them. We have a saying. ECID. Every Cat Is Different. You are certainly seeing that here with Bob. You can't compare one cats SS and insulin dose to what Bob needs. Bob is unique. Although, you may be wishing right now he was a little less unique. ohmygod_smile

Looking at Wink's SS as an example. It's misleading. It looks like he went from 300's and 200's straight down to 100's and OTJ. What is missing from his SS are 4 and a half months of data from the cat shelter when he was in the 600's, 500's, 400's and still on a high carb diet. The way I got him regulated was that switch from high carb Hill's w/d to low carb Fancy Feast classic pate canned food. It was an unexpected bonus to get him to OTJ status. I would have been ecstatic to get him regulated and the diabetic neuropathy better and I did.

Unfortunately, insulin is a hormone. It acts differently than say an antibiotic pill that is targeted to kill bacteria. People taking hormones all react differently to the same dose and the dose needs to be adjusted. Same situation here with the insulin and our cats. ECID. Every insulin dose is different.

There can be many factors contributing to Bob's lack of response to the insulin. I only know a few possibilities.
1. dose - we may not be at the right dose yet. May need to increase. Soon, but not tonight.

2. diet - higher carb diet can contribute to the higher insulin dose required. Vet research shows low carb diet, 12% is best. Our experience has shown that <10% carbs is best. The dry food you are feeding may be too high in carbs for Bob. I'd like to see you try a different food. There are other dry food options.

3. weight - If Bob is overweight at all, that can contribute to insulin resistance. Please ask your vet to weigh Bob and tell you how much weight he needs to lose, if any, and what his ideal weight would be. Vet research shows this

Insulin sensitivity is decreased by half in obese cats and some obese cats have insulin sensitivity values within the diabetic range

from this article http://www.uq.edu.au/ccah/index.html?page=43609&pid=0

4. male - Bob is a male cat. Male cats tend to develop diabetes more often than females. They also show more insulin resistance. Vet research shows this. So that could, only could, be one factor.

Gender influences the risk of diabetes in male cats by influencing insulin sensitivity. On average, even when lean, male cats have lower insulin sensitivity and higher insulin concentrations than female cats. Male cats are also more at risk of obesity, further decreasing their insulin sensitivity.

from this article http://www.uq.edu.au/ccah/index.html?page=43391&pid=0

5. IAA - insulin resistant antibodies. Some cats develop insulin resistant antibodies for some reason. We usually do not consider this until the dose of Lantus is above 5 units. It's a blood test and since you are going to see your vet next week, you may want to ask about this test. I think it might give you some peace of mind and let you know if this is an issue or not. If it is, we'll increase the dose every 3 days until he starts hitting good numbers or at least dropping down to some yellows and blues mid cycle or showing better response.

6. Physical inactivity - Again, vet research shows insulin sensitivy is influenced by physical activity. Increase play time with Bob and you may see some improvement.

Physical inactivity leads to insulin resistance, independent of obesity. Urban cats have very low levels of physical activity when compared to feral cats, which hunt to obtain all their nutritional needs.

from this article http://www.uq.edu.au/ccah/index.html?page=43391&pid=0

Do you start to get an idea :idea: of why this is so complicated? I'm sure I haven't listed all the factors that can influence the action of the insulin and the resulting BG numbers.

Questions for you to follow up on if you would be so kind :?:
1. What dry food are you feeding? brand and specific name And quantity for 24 hours.
2. Are you feeding any canned food? brand and specific flavor and style (pate, chunky, shreds)
3. Would you be willing to try to change the diet to a lower carb dry food if it might help Bob? It can be really hard to make a diet change, especially with a picky cat. There are some other dry foods out there that are probably lower in carb then the one you are using. It takes time and perseverance. And a slow transition. I did it with Wink but it was very difficult to put it mildly.

Action items for you, my recommendations :!:
1. Ask your vet about testing for insulin resistant antibodies IAA
2. Ask your vet about Bob's weight and ideal weight
3. Get a +2 when you can. If tonight's +2 shows some potential action, we'll have you get some more overnight tests.
4. Increase active play time with Bob. 5-10 minutes B.I.D. Think of this recommendation as if it were a prescription from your vet. If he isn't a cat that likes playing much, throw pieces of his dry food, one at a time for 5-10 minutes, so he has to chase after it to eat.
5. update your user control panel, profile, edit signature with your food selections that Bob is getting. Be specific please. And maybe add a comment about why he is on the dry.
6. Keep posting in this thread, even if the question changes. You can go back to your very first post in this topic and change the subject line by clicking on that edit icon on the right.

Scream and yell and rant all you want in your post. We understand. We have been there. We'll try to provide the support you need.

I'm going to ask you to please, one more time, put those patience pants back on, leave your beautiful raven/blonde/black/chestnut/red locks alone and give it some time. This is a marathon not a sprint. It's going to take as long as it takes. We will work diligently with you, as much as you want or as little as you want.

Please also remember, this is not only about the numbers, it's about how Bob is feeling, the 5 P's, peeping, pooping, preening, playing, purring and the appetite. Those clinical signs tell us how Bob is feeling. If some of those are better, then we are making progress.

 

[Libby and Lucy]

Thanks so much! I needed to hear that! Someone on the Lantus board told me since Bob has not gone below 300, I should go ahead and start increasing him .5 units every 6 cycles so I think I will do that. And I'll stay away from the train tracks! It would just be nice to see some colors other than pink and red on his sheet!

Sounds like a plan. And I can relate. It seemed like it took FOREVER for Lucy to be regulated, and I definitely remember how it felt to see a lot of other kitties who joined at the same time we did go off the juice while she was still climbing up the dosing ladder. She did get there, though, and Bob will too.

Since he is eating dry food, you don't want to follow Tight Regulation to the letter (you can't let him run in the 50s), but I think you're fine to increase aggressively until you start seeing some decent movement.

 

[Deb & Wink]

Hi Dara!

Saw the post you have going over in the Lantus TR forum. I think you may be ready to post over there now. What do you think? They give advice about everything, not just about the insulin.

It's your choice, but I see you got some good suggestions over there today, from Sienne and Gabby, Ann & Tess, Angela & Blackie and there will be others. There are lots of people over there, with lots of experience, to give you suggestions too.

There is no rush to post in one of the insulin specific support groups. I like to suggest that people go over to their insulin specific support group and check it out. Read the Stickies at the top of the Topics section. Read a few condos posted by other members. Get a feel for how the forum works. See if you think it would be a good fit for you.

Lantus actually has 2 forums, the ISG Lantus TR and the ISG "Relaxed Lantus". More active in TR so if you need an immediate answer that is the place to post. Probably 50-65 people post there on a regular basis. I counted one day, there were 83 condos so far with that days date.

Relaxed Lantus is a bit more laid back. More people following SLGS protocol there. Much less active, maybe 6-8 people posting on a regular basis. Hold the dose longer. If you need an immediate answer to your post, and aren't getting one, do a new post with a link to it in both the Health and TR forums.

Whichever protocol you decide to use with your Lantus dosing, be assured there are people familiar with the 2 different protocols in both these forums.

As we have said before, you are always welcome to post here in the Feline Health forum for as long as you want.

How to post over there:

Here’s how to post in ISG forums
Every day ( or as often as you can) you open a new thread/post. We call them "condos" (short for condition report).
- The subject has the date/cats name and BG readings ie 06/23 CATname AMPS 400 +2 333 + 5 224. You add a ? icon if you have a question. You can update your subject as you get a reading, or whenever

- The contents of your post have a quick update on how your cat is feeling as regards the 5Ps ( peeing. pooing, preening, playing and purring) and any questions and a link to your previous post ie : Today CATname was in a good mood, playing and eating well. But he is peeing a lot and his BG is really high. Should I increase the dose?

For your first post put "newbie" also in your subject so everyone can welcome you!

You have your SS set up and profile data and are comfortable with home testing. I think you are ready for the Insulin Support Group. We'll miss you but we'll check in on how you and Bob are doing from time to time. You can still PM me and have me come take a look at your condo in LL too. I'd be happy to do that.

Why don't you go back to LL TR and change the subject line in your first condo there by clicking on the edit icon in the very first post of the day. "6/25 Bob AMPS 500 newbie dose help!" That way everyone will welcome you.

 

[Lkldcatlady]

Thanks Libby and Deb! YOu guys are so helpful!! I will continue my posts on the Lantus site, but I did want to give you a quick update!

Questions for you to follow up on if you would be so kind
1. What dry food are you feeding? brand and specific name And quantity for 24 hours.
2. Are you feeding any canned food? brand and specific flavor and style (pate, chunky, shreds)
3. Would you be willing to try to change the diet to a lower carb dry food if it might help Bob? It can be really hard to make a diet change, especially with a picky cat. There are some other dry foods out there that are probably lower in carb then the one you are using. It takes time and perseverance. And a slow transition. I did it with Wink but it was very difficult to put it mildly.

1. Purina DM Dry - 1/3 cup 7:00am and 7:00pm (am trying to transition to EVO dry)
2. No canned food. Every now and then I put something down for him and if there is tuna in it, he will lick it for a while
3. See #1 - going to try the EVO. He doesn't do too bad, but i swear I saw his numbers go up when I started giving him the evo with the DM. Maybe it was just something else because it's more than 1/2 less carbs.

Action items for you, my recommendations
1. Ask your vet about testing for insulin resistant antibodies IAA
2. Ask your vet about Bob's weight and ideal weight
3. Get a +2 when you can. If tonight's +2 shows some potential action, we'll have you get some more overnight tests.
4. Increase active play time with Bob. 5-10 minutes B.I.D. Think of this recommendation as if it were a prescription from your vet. If he isn't a cat that likes playing much, throw pieces of his dry food, one at a time for 5-10 minutes, so he has to chase after it to eat.
5. update your user control panel, profile, edit signature with your food selections that Bob is getting. Be specific please. And maybe add a comment about why he is on the dry.
6. Keep posting in this thread, even if the question changes. You can go back to your very first post in this topic and change the subject line by clicking on that edit icon on the right.

I will definitely follow up with the vet on this information. We are going to the specialits on Thursday morning. I have started trying to play with Bob more and hopefully that will help. Deb, I definitely want you to stay up-to-date on Bob! You are very helpful!

 

[Deb & Wink]

I will definitely follow up with the vet on this information. We are going to the specialists on Thursday morning. I have started trying to play with Bob more and hopefully that will help.

Sounds good thank you for the update.

Deb, I definitely want you to stay up-to-date on Bob! You are very helpful!

I'll be following along with Bob over in LL (lantus land, ISG Lantus TR). I may not comment often but I will be watching, lurking behind the scenes so to speak.

If he takes to the EVO right away, that's great. If not, we can make the switch more slowly, cutting back a bit each day on the DM and feeding more of the EVO, mixing it all together in one dish for him. It will be fine for your other cats too.

 

[BJM]

There are a few secondary Monitoring Tools in my signature which you may find helpful, particularly the urine testing for ketones. Ketones are a by-product of fat breakdown for calories. Too many may indicate diabetic ketoacidosis (DKA), a potentially fatal, expensive to treat, complication of diabetes.