Is this as good as it gets?

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nepenthe

nepenthe

Member Since 2010
Chingis has been doing a lot better since a month ago. Off a 2-year low dose of prednisolone in early December 2012, and then overcome a bad bout of p-titis.

Now he's been getting pretty steady blues (eg., between 106.2 and 208.8 in the past 8 days). Sometimes weirdness like "inverted nadirs", but good numbers. (And the odd high when I've played around with diet)

Until a while ago, I was thinking of switching to Levemir, but am now wondering - is this as good as it could get, in terms of numbers?
 
It can get better. I'm assuming you know that Lantus (and Levemir) dosing is based on the nadir -- in both the AM and PM cycles. Is there any way you can start to get at least a before bed test every night?

You may also want to take a look at the Tight Regulation Protocol sticky above. Lantus dose should be evaluated far more frequently than what you're doing.

FWIW, I would not switch to Lev at this point. You're getting good results from Lantus and I see no reason to switch. 2 mos. is not enough time to evaluate the effectiveness of Lantus.
 
Your kitty's numbers aren't too bad, but I agree with Sienne, that you need to get some PM mid-cycle or at least before bed tests done, too. Often cats will go lower in the PM cycle.
 
Sienne and Gabby said:
It can get better. I'm assuming you know that Lantus (and Levemir) dosing is based on the nadir -- in both the AM and PM cycles. Is there any way you can start to get at least a before bed test every night?

You may also want to take a look at the Tight Regulation Protocol sticky above. Lantus dose should be evaluated far more frequently than what you're doing.

FWIW, I would not switch to Lev at this point. You're getting good results from Lantus and I see no reason to switch. 2 mos. is not enough time to evaluate the effectiveness of Lantus.
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I think I am going to do some tests in the middle of the night. He has been on Lantus for the past 2 yrs, but spent the 2 yrs bouncing b/c of the prednisolone he was on during that period. (it turns out that he was on it for no good reason)

When you say "the dose should be evaluated" more often, you mean doing a curve?
 
You can do a curve. The alternative is to get (somewhat) random spot checks so you fill in the blank spaces on your SS. Basically, with Tight Regulation, if numbers are under 200 the way Chingis' are, you hold a given dose for 5 days. If the numbers aren't in the 50 - 120 range, you increase the dose. The goal is to keep your cat in the normal BG range. If the numbers are in this range for a week or if numbers drop below 40 for a longer term diabetic like your kitty, then you reduce the dose. That's what I was referring by by evaluating the dose.
 
I agree with Sienne and Dyana. If you could get a nighttime number close to his nadir, it would allow you to see if you can increase the dose by .25u. I wouldn't be surprised if you have some room to increase but I wouldn't do it without first seeing how low he might be going at night.
 
Sienne and Gabby said:
You can do a curve. The alternative is to get (somewhat) random spot checks so you fill in the blank spaces on your SS. Basically, with Tight Regulation, if numbers are under 200 the way Chingis' are, you hold a given dose for 5 days. If the numbers aren't in the 50 - 120 range, you increase the dose. The goal is to keep your cat in the normal BG range. If the numbers are in this range for a week or if numbers drop below 40 for a longer term diabetic like your kitty, then you reduce the dose. That's what I was referring by by evaluating the dose.
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Tks for this :)

This brings up one important thing - I've been looking at that "Queensland Protocol" and it has 2 tables for TR with Lantus - one for a human glucometer and another for a feline one. The human one sets a guideline between 50-100mg/dL and the feline (AlphaTrak) one for 80-130 mg/dL.

So, since the human meters rate a little lower, should I take this into consideration when trying to optimize the dose as you've suggested?
 
Use the table that's for the AlphaTrack. Basically, instead of using a 40 as the cut off, use 70. The AlphaTrack is calibrated differently than a human meter and the difference is about 30 points.

We've slightly modified the Roomp & Rand protocol to make it a little tougher for a longer term diabetic to go into remission. The German Lantus board uses a similar criteria but also allows for a dose reduction if the numbers fall between 70 - 80 (on the AlphaTrack) on three separate occasions.
 
Sienne and Gabby said:
Use the table that's for the AlphaTrack. Basically, instead of using a 40 as the cut off, use 70. The AlphaTrack is calibrated differently than a human meter and the difference is about 30 points.

We've slightly modified the Roomp & Rand protocol to make it a little tougher for a longer term diabetic to go into remission. The German Lantus board uses a similar criteria but also allows for a dose reduction if the numbers fall between 70 - 80 (on the AlphaTrack) on three separate occasions.
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One time he did get down to 50 on the AT meter, but had no symptoms.

How does the modification to the R&R protocol make it tougher for LT diabetic to go into remission? (I'm always hoping remission is possible for most of us)
 
When looking at your ss, I see only half...... there are no pm numbers. If you can get a test just before bed, it would be good.
Also, you could add a note on the ss to say testing done with AT.... that being mentioned, your numbers are a bit better than some people may think because your AT numbers are around 30points higher than what others are getting..... so some of your low 100s would maybe show as nice green numbers if you were testing with maybe a Relion meter or some other human meter.

I'd also say to give Lantus more of a chance with a few curves done to show how the insulin is really working. I know many may say that nadir is around +6, but neither of my cats were around that point.... one was more like +5 and the other was at +10 or later. For that reason, when you have a free day, see if you can do a curve and test every 2hrs to see how your dose is working. You get a better picture of how the insulin is really working if you get tests here and there, not just at shot times and then around +6... if your cat's nadir is around +8, you will never know by always testing at +6.

Pancreatitis can take alot out of a cat, and it takes some time to get all out of the system. Also, you want to have the pred completely gone and out of the system as well, so giving Lantus more time, plus a bit more testing, is a good idea. If you find that you aren't getting a smooth curve and better numbers for your cat in a few more months, then you might want to consider switching to Levemir and see if it makes a difference.
 
Blue said:
When looking at your ss, I see only half...... there are no pm numbers. If you can get a test just before bed, it would be good.
Also, you could add a note on the ss to say testing done with AT.... that being mentioned, your numbers are a bit better than some people may think because your AT numbers are around 30points higher than what others are getting..... so some of your low 100s would maybe show as nice green numbers if you were testing with maybe a Relion meter or some other human meter.

I'd also say to give Lantus more of a chance with a few curves done to show how the insulin is really working. I know many may say that nadir is around +6, but neither of my cats were around that point.... one was more like +5 and the other was at +10 or later. For that reason, when you have a free day, see if you can do a curve and test every 2hrs to see how your dose is working. You get a better picture of how the insulin is really working if you get tests here and there, not just at shot times and then around +6... if your cat's nadir is around +8, you will never know by always testing at +6.

Pancreatitis can take alot out of a cat, and it takes some time to get all out of the system. Also, you want to have the pred completely gone and out of the system as well, so giving Lantus more time, plus a bit more testing, is a good idea. If you find that you aren't getting a smooth curve and better numbers for your cat in a few more months, then you might want to consider switching to Levemir and see if it makes a difference.
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I put the note about the AT meter on the top right of my SS, hope ppl will see it.

he got over the p-titis some time in late Dec 2012 - do you think that it could still take a while for the pancreas to really heal?

I wonder what causes some cats to get such late nadirs - where the +10 or +11 basically makes their PS their nadir?
 
How does the modification to the R&R protocol make it tougher for LT diabetic to go into remission
Click to expand...
?

For a short-term diabetic, you would reduce the dose based on seeing a number below 70 on your AT meter once. For long-term diabetics, some folks use a modified version that requires three times below 70 before giving a reduction in dose. So it makes reducing "tougher". It makes it more likely that the reduction doesn't fail, and it's less likely that you would have to keep increasing again back to the "last good dose".


Carl
 
For a newly diagnosed (i.e., within a year of diagnosis) diabetic cat, numbers have to drop below 80 on the AT for a dose reduction. For a cat that's been diagnosed for more than a year, the drop needs to be below 70. That's what makes getting the dose reduction harder based on our modification.

The three times below 80 criteria used by the German forum applies to new and not-so-newly diagnosed cats.

If your kitty is feeling better, then the pancreatitis has resolved. Some cats overcome a bout of pancreatitis quickly and others don't. Every cat is different (ECID).

As for late nadirs, the nadir isn't a fixed point. It can vary. I've had days, like today, when my cat's nadir was probably very late in the cycle. It happens. It may be a matter of a sputtering pancreas, stress (or lack thereof), what phase the moon is in, or the most common explanation -- we're dealing with cats and it's their job to keep us confused.
 
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