Kisa's Curve with Lantus. Need input

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Derek

Member Since 2013
Just did a curve with the Lantis, doesn't seem it's having much effect, so I could use some dosage input please
 
From looking at the data, you've gotten a few numbers on the 2u dose where you weren't able to to shoot because the pre-shot test was too low. You're getting some good mid-cycle test as well but Kisa doesn't seem to be dropping into super low numbers (although that 68 on 2/8 makes me wonder how low she might have gone overnight). I'll be very interested in seeing how Kisa does throughout the curve today.

What is your current "no shot" number? Like, if her pre-shot test is below 200, you skip the shot?
 
It was below 250, now it's 200, though the other day it was really close to 200, and my insulin supply was low so I skipped that dose, but I got a new pen since then, so I'm back to 'everything over 200'
 
You have gotten a couple of months of data. It would be OK to drop your no shot number to 150 mg/dL.

I think some of the long term Lantus users should review your spreadsheet. It is looking like every few shots he goes low and you cannot safely shoot. Then there's a series of pre-shots where the numbers are in the 300s. I'm actually wondering if he might need a dose DEcrease.
 
I have a couple of thoughts that may be helpful:

- whenever you skip a shot, we start out counting of cycles over. Most of the time we re-evaluate a dose every 6-10 cycles for people following the Tight Regulation Protocol. You've just had 6 cycles since the last skipped shot. So . . . if it's possible to get some more data over the weekend like you did today that would really help in deciding what to do with the dose.

- so many, many cats go lower at night that we encourage everyone to get at least one test in the pm cycle every evening. it's amazing how revealing this can be!

I think of a spreadsheet like it is a jig-saw puzzle. you don't have to have every single piece in to be able to see the picture, but you need enough pieces spread out to get the gist of what it going on. i don't feel comfortable suggesting a dose change without a little better picture. You have enough green numbers on the spreadsheet that it's obvious the 2.0 dose is getting Kisa into some great numbers. It might be the higher numbers on the ss are bounces from the lower numbers. It's just really hard to tell. We wouldn't want you to increase the dose if those are bounces. Lantus dosing is based upon how low a dose takes a cat, not the high numbers. I don't know if you're familiar with what we all "bounces" but they are common - description in the second post here.

skipping is a safe choice when you're not going to be home to monitor, but once you understand how lantus works and if you're going to be home to monitor, shooting lower numbers can give you the opportunity to lower the whole range of numbers in a cat. that's the path to going off of insulin, if that is your goal. that's what those of us who follow the TR protocol are trying to do. cats have the unique ability to have their pancreas heal and to become diet-controlled, which is pretty darned awesome! most of us want that!!

So, i'm not sure if i've helped or not. I guess to sum it up, I would say that Kisa looks pretty good on this dose. You're being handed opportunities to lower her whole range of numbers when she gives you a lower preshot, but you can't take advantage of it if you aren't around to monitor. if you are, i'd say move over to posting on the TR forum here and we can teach you how to fine-tune dosing for her and hopefully help her get her numbers flatter. There are lots of people there using Lantus who can help teach you what you need to know to get her as controlled as possible.

i'd also encourage at least one test in the evening cycle because that will really help us see what's going on in her body in the evenings. you don't have to test a zillion times to help fill out the puzzle! It does help to vary the times you test so that there are some tests here and some there all over the ss.

This probably brings up lots of questions - so ask away. I'll notice if you repost on this post and will pop back in.

and nice to meet you & Kisa, Derek! cat_pet_icon

julie

edited to add - i should clarify that people who work full time can follow the TR protocol. You don't have to be home all the time to do it. i'm just saying when faced with a low preshot number, you can't shoot it and leave until you have enough experience and data with your cat to be confident about what Kisa will do after the shot.
 
I tend to be home pretty much all the time to monitor him, the only time I miss a check is when I sleep through it, but the only time I ever miss a dose is when he's low enough that I'm told not to dose him
 
Hi Derek and extra sweet Kisa!!

Just a quick note. I saw on your spreadsheet a note on 2/2 that says "Was told by mother to give another dose when read at 477" and the 477 was at +6.
Please don't ever give another shot mid-cycle like that. It could have been a very heartbreaking morning on 2/3.

As for now, please just try to get more tests in during the PM cycle so we can really see how Kisa is doing. You don't have to test every 2 or 3 hours every day, but at least get some tests in various places in each cycle. A "before bed" test is an important one since cats do tend to go lower at night, so if you get a test result "before bed" that's dropping too much, you'll know you need to set an alarm to get up and test later. If you tend to turn your alarm off and go back to sleep, maybe put your alarm far enough away from you that you HAVE to get up to turn it off. I had to do that for a little while until I got used to the schedule for China.

It's really important that you find a schedule that you can shoot every 12 hours. Lantus does best when it's given at consistent times. I hate mornings, so when we first started, I figured I'd shoot at 11am/11pm....then China would go lower at night and I'd be up until 5-6am testing to make sure she was ok and not dropping too low. That's when we worked our schedule back to 6am/6pm. As much as I hate mornings, shooting at 6am means I can get those mid-cycle tests in on both the AM and PM cycle...and because I'm not a "morning person", I have gotten used to getting up, testing/feeding/shooting by 6:10am or so, and then I'm able to go back to bed for a little while which is fine with me!

Hope you find something that will work for you and Kisa!!
 
well that's awesome - if you're home a lot, we can help you get ready to learn to shoot lower numbers.

Whenever you're ready, just post over on the TR forum and you'll have more help than you ever hoped for. :lol:

a few more tests this weekend will help us be able to give you some feedback on the dose, too. i do think Kisa looks like she's doing pretty well and responding well to the insulin.

i missed what Chris spotted on her ss - she's right, you don't ever want to reshoot. it's not worth the risk. if you mess up on a shot and think it didn't go in, don't worry about it. we've all done it. better to have her too high than too low.
 
Hi Derek:

Just wanted to welcome you to our little world in advance - LL (Lantus Land) is a wonderful place full of caring, knowledgeable people that will help you get Kisa in the best shape possible.

I have to ask about the name. We had a Siberian we named Kisa because it is Russian for kitten. How did you come to use that name, and what breed is Kisa?

Again, welcome - you'll find you're in the right place!
 
I named him that because of an Animal Planet special: Growning Up Lynx, where they had a Siberian Lynx named Kisa, for that very reason. We thought the kitten was female at first, but kept the name when we found out we had a male. I used to think he was just a domestic shorthair, but turns out he's a Bombay. Silly thing is never what we think he is
 
That is totally ironic. We got our Kisa because the person that originally reserved him wanted a male and the breeder said he was a female. We all believed it until the vet tried to spay him! We kept the name because we liked it and he knew it. Our Kisa died one year ago from hepatitis. I miss him very much.

I will keep your Kisa in my thoughts and prayers. I'm glad you are joining us on the Lantus board.
 
oops. my sincerest apologies to Kisa for calling him a her!

I was thinking this morning that i should've mentioned something about the +6 tests. I'm thinking you're testing then because you've read or been told that the lowest point of the cycle is about +6. that is sometimes true, but some cats don't read our manual! :lol: Some cats have earlier or later nadirs. For that reason, it's often helpful to vary the time of the mid-cycle test. Say get a +3 one day, a +4 or +5 another day. The varied times do help us see better what's going on in his body.

How's he doing today?
 
He's doing fine, though it helps that he's fairly well trained for a cat. I bring him into my mother's room while I heat up the sock for his ear, and tell him to stay, then he waits for me to come in. I flip him over, put the sock on his ear, get his blood, give him his shot. Then he walks to the corner of the bed and sits to wait for his treat, which I usually hand feed him. Then he hops up on my shoulder to get carried to the kitchen for breakfast (normally, I'd make him walk, but I'm having issues with fleas, and he's avoiding all contact with the ground that he can). He's a bit strange for a cat, he knows the sit command, the stay command, and a hand gesture to stand on his hind legs, and he walks on a leash with a harness.
 
How cool that Kisa knows a few commands! Maybe you can get some video of him sometime to share with us!?

We'd love to see a picture of him too. You can add an avatar picture of him like most of us have over on the right side if you have a picture you like of him (and who doesn't have a bunch of pictures of their furkids?) You have to shrink it to no bigger than 90x90 pixels though. Here's a program that can do that for you http://www.shrinkpictures.com/create-avatar/

I think it looks like Kisa is going to need more insulin to get his numbers better, BUT without having at least a few more tests during the PM cycle, there's just no way to know for sure. It concerns me that he's staying so high though. Those higher numbers are very hard on his kidneys and you really don't want to have to deal with CKD if you don't have to.

Can you start getting at least a "before bed" test on the PM cycle? It'd sure help to fill in those missing puzzle pieces!

Good luck to you both, and hope we're able to help you to help Kisa. He sure sounds like a very special kitty!!
 
wow, it sounds like he feels pretty good - that's awesome! i'm amazed you've been able to teach him to do all of that. i "trained" punkin to walk with a leash after he became diabetic, although the reality of the "training" was that i followed him under & between bushes and across yards where he wanted to go.

It was hysterical to experience, because i'd never really thought about how different walking a dog or cat might be. when you walk a dog, you go on the sidewalk or road, or at least a path.

with the cat, everything is cross-country. one house in our culdesac is slightly higher than the rest, and punkin really liked to go up their driveway and just park to survey his kingdom. he took me through spider webs, too, which i didn't appreciate very much!

regarding the fleas, one great natural control is Diatomaceous Earth. It's mined crushed shells from a little crustacean called Diatoms. It has the consistency of flour. You buy it at any garden store and it's pretty cheap, like $5 for a good sized bag. I put it in a large strainer, then walked around tapping the side of the strainer against my hand to sift it out. you can put it inside your house, on your furniture, carpet, bed, pet beds and on the pets. It won't hurt them at all. It works even when it gets wet. It has little sharp edges that you won't be able to feel, and when a flea (or carpenter ant) walks through it the dust cuts through the waxy coating on the insect. Then the flea/ant will dehydrate and die.

We were pointed to it when we had a terrible flea infestation and had tried lots of horrible toxic stuff. Nothing worked for long. Then we tried this - no more fleas. You'd want to reapply every week for at least a month to kill through the whole flea life cycle to really eliminate them. you can buy it at a petstore, but it's tons more expensive. hope that helps you.
 
The trick to teaching 'sit' to a cat is easy, just hold a treat that they want up high enough that they can't get it. Their natural response is to plop their butt on the ground and wait for you to give it to them, and perhaps cry to signal that they want it. When you see them do that, just say 'sit', and eventually they make the connection. For 'up', do the same thing, except hold it high enough that they can reach it by standing on their hind legs. For 'stay', it was mostly trial and error. Leash training involves putting the leash on them, and letting them drag it through the house (following them to make sure it doesn't snag and your kitty doesn't hang themselves), and harness training is just put the harness on them for a few days until they walk around naturally with it. Then you hold the leash and follow them. Kisa is only allowed to walk on the wooden wheelchair ramp for the house.

I'll probably do some PM stuff Monday night, as I have stuff to do tonight, and Tuesday is mostly free for me
 
I'm gonna have to try out all this "training" stuff with Henry! He is the most treat-motivated cat I have ever seen! He's just sorely lacking in patience.... :?
 
It's all about cat psychology. Learn how they think, and use it to get them to behave the way you want. It's only fair, since they do it to us
 
I've now posted his numbers for a full PM curve, hopefully between this and his earlier AM curve, you should have enough data
 
I'm really wondering if the dose is too high and that is why you're getting those sudden low, non-shootable numbers.

There are 2 ways to test this out:
1) Start over with the dose calculated using the formula for Lantus or with 0.5 units, and test for ketones while doing that.
OR
2) Try decreasing the dose to see if you get better numbers or a longer period before you get a non-shootable number.
 
I barely have any non-shootable numbers, only 6 in the entire month of February were below 200, and during two of those times his feeding schedule had been thrown out of whack. Also, no idea what ketones are or how to check them
 
If every one of those times there was a food intake issue, that's fine.

The pattern of high, high, ..... low and repeat is what makes me thing the dose is too high. After the reserves get used up, Kisa goes low, you skip, she restocks the reserves, and you repeat.

Ketones are a by-product of fat breakdown for calories. Too many may indicate diabetic ketoacidosis, a potential fatal complication of diabetes. Test strips are available at most pharmacies, although may have to ask for them. KetoStix test just fo ketones. KetoDiaStix test for both ketones and glucose. There are some tips on urine ketone testing in my signature link. Secondary Monitoring Tools, as well as other assessments you might find helpful to do.
 
Derek, while it's really great that you did a curve on the PM cycle, it's just not enough data for us to make an educated recommendation.

There are so many changes in Kisa's schedule due to oversleeping, feeding times and other things that there's no way to really see how Kisa is doing, and the results of 1 curve just aren't enough.

I also think it's possible that Kisa is getting too much insulin. Too much can lead to high numbers as can too little. We usually start our cats at 1 unit every 12 hours, get at LEAST 4 tests per day in (2 Pre-shot tests, 1 test somewhere between +5 and +7 during the day, and 1 test "before bed" at night, at least 2 or 3 hours after the PM shot)

If you can please try really hard to have several consistent days where you're testing, feeding and shooting at the same time every morning, getting at least 1 test somewhere around +5 to +7, testing/feeding/shooting 12 hours after the morning shot and getting at least a "before bed" test at night, we'll have a much better idea of how Kisa is doing and if you might want to increase or decrease her dose. If you could do that for 6 full cycles in a row, it might make it possible for us to advise you. Of course if you can get more tests in, all the better, but we need to see at least 6 full cycles with at least those 2 tests in each cycle. The Pre-shot and either a mid-cycle or a "before bed".

We only change doses in .25 unit increments, never in whole units, and Kisa went from 1 unit to 2 units back in November, and has been getting 2 units ever since. It's entirely possible that 2 units is too much. It's also possible that it's not enough, but without the data to show us one way or the other, we really just wouldn't feel comfortable telling you to increase her yet.

Wish I could be of more help.
 
Tiggy does "paw" by the same logic. I would say "paw" a few times and grab his dominant paw then hold it a sec while saying paw over and over and give him a treat. Didn't take him long to catch on.. Although he lifts and kinda waves his paw a bit, he hasn't quite worked out to put it in my hand.
 
Kisa's never been on 1 unit, only two. Someone else was doing his spreadsheet at the start and never realized that he was one two units, and I never went back and changed the older data. He's been on a consistant 2 unit does the entire time
 
Oh wow! That can make a pretty big difference then!

Would you be open to starting over at 1 unit, testing at least 4 times a day for 3 days (6 cycles)? We would be able to really tell if Kisa needs more, or maybe even less.

2 units is a pretty high dose to start on, and it's totally possible that he might have developed a little insulin resistance or that he's just going too low and then bouncing back high at Pre-shots.

It's important for you to test for ketones too. If caught early, they can usually be treated at home, but if you don't catch them soon enough, they can cost a lot of money in vet bills...or worse. To test for ketones you just get some of the strips that BJM talked about earlier and dip them in urine, and read the results. Here are some Urine collection tips to help you.
 
Given his litter habits, I don't think that'll be possible. Also, I doubt I could afford the other strips. Also, any change in his litter type tends to annoy him, the to point where he avoids the box entirely
 
Well, today he tested at 563. I don't think the 1 unit dose is helping. So I think I should either go back to 2 units, or see if someone can suggest a higher dose
 
Lantus dosing is based on the lowest point in the cycle, not the pre-shot numbers. Is it possible for you to grab some mid-day tests on your day off or a before bed test every night? That would help the advice-givers. Unfortunately, most advisors here aren't comfortable giving advice on dosing without those numbers.
 
Been meaning to try some mid cycle stuff, but my sleeping has been way off lately, and the alarm hasn't been waking me to catch them, I'll see what I can manage over the next few days
 
As a person who is very attached to sleeping, I hear ya! I knew I really loved my cat when I started setting my alarm for a 3 am test. And when I got up before 7am on the weekend to make sure her shot was on time. :lol:

Good luck!
 
high numbers can be a result of having hit lower numbers than kisa is used to. without midcycle tests there's no way for us to know whether it's a case of bouncing or not enough insulin. i'd lean with not enough insulin, but can't say it with confidence.

i see why you are concerned, however, because Kisa's preshot numbers don't look good. those are not good numbers for him to stay in. His numbers did look better with 2units, but with green preshot numbers the 2units may have been too much - probably something in between would've been better. Are you using the pen needles that come with the Solostar pens and dialing the dose on the pen? we have found with cats, you almost always will be making dose changes in 0.25u increments (one quarter of one unit). One unit adjustments are too much. We use u100syringes, 3ml, that have 1/2 unit markings. the Terumo Thinpro syringes at American Diabetes Wholesale are less than $14 per box of 100. You can also buy inexpensive strips through them - if you buy 4 boxes of the Arkray Generic that fit whatever meter you have, you can get a 5th box free. If you register first at http://www.mrrebates.com you can get a rebate back on everything you buy at ADW through them. These all make the cost more bearable.

as far as getting tests in, they don't have to be at the perfect time for us to be able to help you with dose. but we need something. going back to my earlier metaphor of the spreadsheet as being a jigsaw puzzle, what we have with preshot tests is the edge pieces.

Here's a link to using Lantus/Lev and how to help it last as long as possible: http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=151 If you haven't used a syringe separately before, you'll want to watch the video on how to draw up a dose. i'm thinking because you're doing 1unit adjustments you likely aren't using a syringe. i think you'll find that you can get to a better dose and keep Kisa out of these higher numbers if you make these changes.

you said you're home most of the time. you don't have to wake up to get tests in, just catch one before you go to bed. and during the day, get one test in. as you saw with that nice 177 a couple of nights ago, he isn't staying high the whole time in between shots. we just need to see what he is doing. i would definitely not increase him back to 2units.
 
Hi again Derek!!

As Julie said, without knowing where Kisa's blood glucose has been, there's just no way to know if he needs more or even less insulin. I agree it's probably more, but that's just a guess at this point.

When we suggested dropping back to 1 unit, we just wanted to see how he did for the next 3-5 days. You don't want to hold a dose too long that's not effective either. If you can just get at least 4 tests a day in, we'd have a much better idea of what to recommend, and if it was to increase, we'd want you to only increase in .25 unit increments. Tiny amounts of insulin can make a big difference, so it's important you have syringes that measure in half unit increments (we wish someone made them with quarter unit lines but they don't)

Since you're at home, just get one sometime mid-cycle in the day, and one test before you head to bed at night. That will help us to help you and Kisa

At the kind of pre-shot numbers you're getting, it's really important that you get some ketone tests in too. I know you said that Kisa wouldn't let you anywhere near the litterbox while he was using it, but there are ways around that too. Aquarium gravel that's been rinsed really well and then used as litter is one way since it doesn't absorb the urine.

Good luck Derek! We can help you get him better controlled, but we would need you to get those tests in and keep us up to date on how he's doing. We really do want to help!!
 
I usually recommend 3-4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low the cat’s blood sugar is going. The low point "nadir" is what you base dose changes on since you don't want the cat dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what the cat's overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.

It might help to move your shot time so that the before bed test is 2-3 hours after your nighttime shot. And if you are working, mid day tests at weekends are good.
 
Sorry about not replying, apparently my email alert thingy never notified me that there were posts. I put him back on his original 2 units that the vet had told me, and he regularly hits 200 and 150s, so there have been a few days where he hasn't needed his shot for one cycle. I'll try and get his mid cycle stuff when I can
 
As you collect data, you can set the no shot limit lower, if you have nadir data to show it is safe.

I don't know if you've seen the glucose reference ranges below, so I'm adding that, just in case

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

* * * * * * * * * * * * * * *​
Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
Hi Derek. Come on over to the tight reg group. My Max was diagnosed mid November. I only started testing at home in January and at first not too many times a day. At the prompting of Wendy and Julie I tested at night and found that is when Max goes green, much more often than during the day. I was quite surprised!

I just learned about Mr. Rebates by reading your condo. I have been buying from ADW but didn't know about the rebates. I need to learn how it works because I will need to reorder again this week. I went through a ton of test strips yesterday. i am using the generic ones for my relion and they work just fine.
 
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