Is this normal? Plz see my spread sheet.

[evakot]

Hi All,

This is my first time posting on Lantus board, so let me briefly introduce my kitty.

His name is Big Kitty and he is 9 years old. He was dx with FD in January 2010, but thanks to the advice on the main board he went into 8 months of remission, after only 3 insuline shots and a complete switch to low carb diet. Sadly, about 2.5 weeks ago he relapsed, and his numbers were ranging from mid 200s to upper 300s. He doesn't have any other health issues.

So, he is on Lantus since Sunday, but if you look at my spread sheet, he does not seem to be responding to his shots at all. The numbers that I am getting are on avarage the same as before we started shots.

Here are a few questions:
1. Is it possible that this dose is too low for him? He is a big cat- he is 17lb now; his ideal weight should be 15.5lb. I know not to raise the dose too fast, but just wondering if 1u is just not enough?
2. No matter how hard I try, every time I draw insuline I get a very small bubble of air in the syringe. Is it possible that due to air bubbles I am not even giving him a full 1 unit? Is there any way to not get the bubble in?
3. Is a flat response like his normal in the beginning? Does it take some time for insuline to take hold?
4. How long should I stay at the same dose before considering raising it? By how much should I raise?
5. Big Kitty is a "snacker." he eats 1/2 can for breakfast and 1/2 for dinner, but in between meals he snacks about every 2-3 hours. A snack would be a heaping teaspoon of wet food, or some boiled chicken. Are his eating habits cotributing to the numbers not falling?

I am really one worried momma. Was hoping for some relief for my boy with the shots, but nothing is happening.

Would appreciate any advice.

Thank you,
Eva

 

[Nicole and Napoleon]

Hi Eva,

I am sorry for the relapse. I would definitely start by reading the Lantus stickie if you haven't already. It is full of awesome info. What you are seeing is normal. Lantus is very different from PZI, Humulin,etc. Lantus takes time to build a shed before it starts working. I would give it a week if I were you (10 full cycles) at least unless you are dealing with ketones. I get Monoject syringes. They get air bubbles too but I find that they are very easy to get rid of by tapping a few times and expelling the air. Overfill your syringe by a unit or two and tap it a few times until you see the air bubble move to the top, then push up the plunger. Never expel excess insulin back into the cartridge or vial of Lantus though, it will make it go bad much faster. Not sure if you were aware, just thought it would help to tell you. Those frequent snacks are actually good for him. It should keep his BGs stable once the Lantus kicks in and keep him from dropping too much. I think you are doing the right thing with his eating habits. Those numbers are not as bad as you think, check out our SS. Still trying to get Napoleon regulated and he has been in red quite a few times. It will get better very soon. Just follow the protocol in the stickie and you will be back on track in no time.

Hang in there, the chances of remission are very high. Hopefully Big Kitty will return to the falls very soon.

 

[Jill & Alex (GA)]

welcome to the group eva and big kitty! sorry to hear big kitty is back on insulin.

His name is Big Kitty and he is 9 years old. He was dx with FD in January 2010, but thanks to the advice on the main board he went into 8 months of remission, after only 3 insuline shots and a complete switch to low carb diet. Sadly, about 2.5 weeks ago he relapsed, and his numbers were ranging from mid 200s to upper 300s. He doesn't have any other health issues.

what insulin was big kitty on the first time? has big kitty been checked out by your vet to make sure there's nothing going on health wise?
health issues/infection/bad teeth will often knock a kitty out of remission. if the issues aren't addressed, it'll make it that much harder to get him back into remission.

So, he is on Lantus since Sunday, but if you look at my spread sheet, he does not seem to be responding to his shots at all. The numbers that I am getting are on avarage the same as before we started shots.

what you're seeing is not unusual. the action of lantus is cumulative. one dose builds upon the next.

Here are a few questions:
1. Is it possible that this dose is too low for him? He is a big cat- he is 17lb now; his ideal weight should be 15.5lb. I know not to raise the dose too fast, but just wondering if 1u is just not enough?

yes, it's possible the starting dose is a little low. using the formula for a starting dose based on ideal weight, the initial starting dose would be around 1.75 units.

2. No matter how hard I try, every time I draw insuline I get a very small bubble of air in the syringe. Is it possible that due to air bubbles I am not even giving him a full 1 unit? Is there any way to not get the bubble in?

if there's an air bubble in the syringe... yes, the dose is probably a tiny bit less than 1 unit. others will stop by with ideas for getting rid of the bubbles.

3. Is a flat response like his normal in the beginning? Does it take some time for insuline to take hold?

yes, it does take some time for the real effects of the dose to be seen. however, it's also possible/probable the starting dose is too low.

4. How long should I stay at the same dose before considering raising it? By how much should I raise?

i respectfully disagree with nicole's suggestion to hold the dose for a week. since the numbers are rather high and flat, i would go ahead and increase to 1.5u bid in the morning since it appears that you're available to test frequently. this suggestion is based on the starting dose being on the low side and the high flat numbers you're seeing.

5. Big Kitty is a "snacker." he eats 1/2 can for breakfast and 1/2 for dinner, but in between meals he snacks about every 2-3 hours. A snack would be a heaping teaspoon of wet food, or some boiled chicken. Are his eating habits cotributing to the numbers not falling?

generally speaking, we like to withhold food for a couple hours before shot time so that the preshot number is not influenced by a food spike. at this point, i wouldn't worry about feeding a snack every couple of hours.

I am really one worried momma. Was hoping for some relief for my boy with the shots, but nothing is happening.

hang in there, k? it takes lantus awhile to buildup in kitty's system. in the mean time, please check for ketones. has big kitty ever had ketones or DKA?

read the stickies (starred posts) at the top of the forum if you haven't already. lots of good stuff in them!

getting a kitty back to the falls the second time often requires a more aggressive approach than getting them there the first time.
post often. continue asking questions. someone is always around to help.
hope to see you posting often!

 

[Sienne and Gabby (GA)]

Welcome to Lantus Land!

First, take some time to read the starred, sticky notes at the top of the Board. (Sorry -- we'll all tell you that!!) There is a huge amount of information in these notes -- everything from our dosing protocol, how to become data ready, caring for Lantus, the kind of syringes you'll need, what a curve looks like, our slang and much more that I'm forgetting!

One of the differences between Lantus and other types of insulin is that it is a depot drug. We refer to the depot as the "shed." There's a sticky note about this, too. What's important for you to know at this point is that for the first few days after you start using Lantus, a small amount of each shot forms a "storage shed" under the skin. Once the shed is built, Big Kitty will begin to have more of a response to Lantus. The shed is, in part, what gives Lantus it's duration (it's a long acting insulin) as well as allows overlap between doses. Right now, it's important for you to be patient. Raising the dose, as Jill suggested, will help but even with increasing the dose, the shed has to catch up. This can take a couple of days.

Take a look at the sticky on our dosing protocol It will give you a feel for when to increase dose and by how much. But by all means, post so we can help you get familiar with the protocol and interpret Big Kitty's response.

If you don't already have them, you will need syringes that are marked in 1/2u increments. We make dose changes in 0.25u so having syringes that are in half units will make your life much easier.

As for bubbles:
1. Throw away the plunger cap and move the plunger a couple of times. (Jojo told us that spreads the plunger lubricant)
2. Make sure the plunger is all the way to the needle end, uncap the needle, and insert the needle into the insulin cartridge.
3. Pull the plunger back pretty far, maybe the 4 or 5 IU mark. The vacuum inside the cartridge "fights" this; it goes slowly.
4. The insulin will start moving into the cylinder very slowly, watch to see how much is in the syringe.
5. When there is about .5 IU more insulin than needed, withdraw the needle from the cartridge without moving the plunger.
6. This causes the insulin to move down to the plunger (away from the needle), and the air goes up to the needle end.
7. Put the cartridge back in the fridge; do the rest of this over the sink.
8. Press the plunger to expel the excess air at the top. (don't skip this step, even if there are bubbles! The less air is in the syringe when you flick on it, the easier it is to form a single bubble that can be pressed out.)
9. If there are any bubbles at this point (often there are not), flick the syringe to bring them to the needle end.
10. Twist the syringe while pressing the plunger slowly to expel any remaining air, and to "dial in" the desired dose. This way, you can see if the bubble is sticking to the side, because you're rotating the syringe and looking at it from all sides.
11. If there's a bubble stuck to the side of the needle collar, draw a tiny bit more air in to join it, and then rotate the syringe the opposite direction to last time, while pressing the plunger. This spins the bubble together and hopefully centers it on the needle hole so you can squeeze it out.
12. Because we do micro-dose, when dialing in doses, we try to hold the syringe so the angle on the needle is facing up. This way, the little drop of insulin that forms there can be pulled back into the needle without bringing air, if we accidentally dial the plunger in a drop too far.


Please let us know how we can help!

 

[evakot]

Thank you All for being so welcoming and infomative. It feels so good to know there are people here to guide me and support me.

To anwer some of your questions:

what insulin was big kitty on the first time? has big kitty been checked out by your vet to make sure there's nothing going on health wise?
health issues/infection/bad teeth will often knock a kitty out of remission. if the issues aren't addressed, it'll make it that much harder to get him back into remission.

He was given 4 units of Humulin N by the vet and sent home with instructions to do this BID. Luckily, I found this board in the meantime. I changed his diet to LC and gave 2 more shots of 1 unit. I learned to home monitor (even though my beginnings were full of ups and downs). Before his scheduled fourth shot he was at BG=130, so I didn't shoot. From there he went to being in the 70s consistently over the next 8 months. That was a wonderful time.

Big Kitty was checked by the vet last week and he seems healthy otherwise, other than for inflammed gums. I know that teeth issues can contribute to relapse, and I discussed this with my vet thoroughly. However, she does not want to schedule a dental before he is somewhat regulated. I could not convince her otherwise. She said- give it a few weeks, and in the meatime she gave me an anitbiotic to give him to "lower his bacterial load," in case the gums are a breeding ground for bacteria.

in the mean time, please check for ketones. has big kitty ever had ketones or DKA?[/

quote]

He was checked for ketones at the vet last week and was negative. How do I do that at home? I know I need to use ketone strips, which I do have, but how do i stick it in his urine? Is sticking the strip in the litter immedietly after he pees enough? How often does that have to be done?

Sienne and Gaby- Thank you so much for detailed instructions on getting rid of bubbles. I've done this this morning and I think I got it right this time.

Thanks again everybody!

Eva

 

[Pat+Raja+Shadow (GA)]

Hi Eva...and Welcome to you and Big Kitty!

You can get a box of ketone strips at any pharmacy. Then you will need a fresh urine sample. Some of us have had success by putting our kitty in the bathroom with a little box that ha been covered with Saran wrap so we can get a sample. If your timing is good though, you can catch the stream and do a test from that.

I am sorry to her that Big Kitty's numbers have gotten higher lately. I am very disappointed that your vet would not consider a dental though. My Shadow has one twice a year. His numbers start inching higher than normal and I believe it is from inflammation in his gums. There is no reason why a diabetic cat should not have a dental with the proper care during the procedure. If the inflammation or infection is causing the high numbers, you are in a vicious cycle if you do not get rid of those issues.

Here in LL we have so many kitties and have gotten a routine going to keep the posts orderly. We each post ONE condo (thread) per day per kitty. We show the header : Date, Kitty's name, AMPS_____
We also link the previous day's condo to the first post of each day. that way, we can click on the link and read what transpired the previous day.

Can you post a condo today for Big Kitty? Have you read the stickies at the top of the page? Please be sure to have HC gravy on hand and karo syrup too....the list for the HYPO kit is in the first stickie "New to the Group?" viewtopic.php?f=9&t=18139

Please read that and post a new condo for Big Kitty for today. any questions you might have can be posted in your condo then...okay? Again, welcome to you both! So happy to see you here...and I look forward to your daily posts! :mrgreen:

 

[evakot]

Here in LL we have so many kitties and have gotten a routine going to keep the posts orderly. We each post ONE condo (thread) per day per kitty. We show the header : Date, Kitty's name, AMPS_____
We also link the previous day's condo to the first post of each day. that way, we can click on the link and read what transpired the previous day.

Hi and thank you for the welcome.

I'd like to post my first condo. Could you please point me to the directions on how to include a link to a previous thread? I'd like to link my condo to the background info I provided on my cat in a post from yesterday. I looked around but could not find instructions how to do that.

Thank you!

E