Lantus, IBD,HCM

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Hosanna

Member Since 2012
I am very new at this, and from what I've been reading, I think I need to start low, go slow. Thus am finding my way around and to this board. I am in the process of reading all the starred material, but I don't want to rush through it.
Martha was diagnosed with DM this past July 5th. I am beginning to think some of her other health issues are interfering with treating her diabetes. For example, she has struggled with IBD for about 5 years now---and so the issue of steroids could very well have a bearing on Martha's bg control.
She started off on prednisolone. About a year ago we switched her to dexamethasone. (Not quite sure the vet's reasoning). Then last year we began getting high bg readings on her regular bloodwork. Knowing diabetes could be right around the corner, we switched her to budesonide. That's supposed to act locally in the gut more than systemically. I breathed a little sigh of relief at that switch. Short-lived.
This past May 28, she seemed to be having an IBD flareup so the vet increased her budesonide from 1 mg to 1-1/2 mg. Two days later, Martha had full blown neuropathy and was sliding around instead of walking. The vet saw a possible connection and I, on my own initiative, put her dose back to 1 mg.
Now my question is, and I so hope this group can help me here--is the budesonide having an affect on her bg? If so, is there anything I can do to change that?
We went a whole month with her having that dreadful neuropathy before anything was done. I do understand part of the reason for that was she also has HCM and we were trying to keep as much stress off her as possible, and the "White coat syndrome" would sometimes send her over the edge. But this is the same vet who had her on 4 units of Lantus within the first few weeks of treatment, and she ended up with hypoglycemia. I love this vet to pieces but, over time, I have come to not trust him so much any more.
No point in saying to change vets because I already have the very best Internist and Specialized medicine clinic in the whole state. Her cardiologist is also with that clinic and he told me this week, after her scheduled echo, that, while she still has serious and advanced heart disease, it is getting better as we bring down the BG. Yay for that!
The medicines she is on are: budesonide, of course; amlodipine, benazapril, prozac (behavior issues), COQ10, B12 Meth, Miralax. Occasionally I will give her slippery elm.
I hope I am making sense, it's hard sometimes to formulate what I want to say. But I feel so alone in all this diabetes business and will appreciate any and all help you can give. If I ever sound "scattered," it's probably because I am....
 
Welcome to Lantus Land, the best place you never wanted to be! :lol: :lol: You are not alone dealing with Martha's diabetes any more. I don't know the answer to your question about the budesonide but I expect someone will. A cat's blood glucose can be all over the place, so don't be distressed with her numbers. They are actually pretty good. I do have two recommendations for you. One is keep the dose the same for the AM and PM shots. You need to be very consistent with Lantus. You also need to shoot exactly 12 hrs apart each time. My second recommendation is to get a mid-cycle check both in the morning and the evening. Lantus dosing is based on the nadir and you need to have some idea what that is.

You are doing a great job with getting the spreadsheet set up and posting here. Please ask as many questions as you have. There is a lot to learn and it's overwhelming at first. We've all been there and understand. We want to help Martha be as healthy as possible.
Liz, Zener's other mom

ETA: Sienne posted some good information in your earlier posting. Did you see that? We normally just do one condo (that's what we call each post) per day for each cat. It keeps the board a little easier to read.
 
So I need to do a mid check at 3 pm and again at 3 am? I do not understand "nadir," and how the dosage is based on that. It is my understanding that if she has a reading of, say, Below 175 at any pre-shot test, to give NO insulin.
I don't understand "condo"--that means I will only get one response per day?
 
Hi Hosanna,

Budesonide is also a steroid and as such it probably does increase the bg, but how she is getting it makes a big difference also. I see that it is available in different forms, ie: an inhalant, nasal spray, as well as orally. An inhalant would cause less harm than oral medicine would but I don't know if that would be worthwhile for IBD. Sometimes there is nothing that can be done about it. We just have to use the steroids for other problems that our kitties have but it is a corticosteroid and if there is a medicine that is not a steroid that works it would be preferable. That said, lots of us give our kitties steroids for other conditions if we have no choice and my Racci takes a strong dose of a steroid inhaled medicine, Flovent, for her asthma twice a day and still has low bg's. She's usually in the green and blue numbers. If Martha is taking it orally, you might want to ask the doctor if the inhaled version would help her problem & be safe for her other problems.

Melanie & Racci
 
Nadir is the lowest BG of the cycle (each shot is one cycle). So, if the nadir is between 50 and 200, the dose is good. If the nadirs are above 200, you will increase the dose. If the BG ever goes below 50, you will give her food/carbs to bring up the BG into the normal range, then decrease the dose at the next shot. So you get a mid-cycle check to see what the nadir is. You are shooting at 9 am/9 pm? You don't have to do the mid-cycle check at the same time every day. In fact, it's good to change it so that you can see what Martha's cycle typically looks like. Some cats have a nadir at +3 or +4 (3 or 4 hours after the shot), others at +6 or +7, and others are inconsistent (like our cat :roll: ). You can get a +3 or so, just before going to bed for the night cycle.

The pre-shot test is to make sure you don't give her more insulin when she is already low. The 175 is a good starting point. If she's below that at pre-shot, do not feed (it took us forever to get that one because our gut reaction was to feed :lol: ). Then post here and someone will help you. You will test again in 20 mins and make a decision from there. Basically, you can stall and test again (still without feeding), skip the shot, or give a reduced dose. There are pros and cons to each one. The goal is to gradually lower the pre-shot BG so that you can get Martha's numbers as much in the normal range (50-120) as possible. Below 200 is good too, since that's the renal threshold for cats. It sounds scary and it is but you'll figure it out and you will see Martha do better as her BGs get in better numbers.

We like to just see one topic per day. You can put as many responses in one topic as you want. Does that make sense? It just keeps everything about a cat in one place. We call a topic a "condo" because we live here. :lol: :lol:
Liz
 
Just to add a little clarification about your condo:

You can change your subject or add to it if you have a new question by going to the subject line in the first post and clicking 'edit', type in your new question, submit. Click a new post in your condo and write your new post from the 'reply' in your condo like you have been doing.

Melanie & Racci
 
We have a saying around here: ECID, every cat is different. It's really amazing how unique they can be. The corollary to that is: Know thy cat. :-D
Liz
 
Here's the link to the other condo you started today.

A condo is Lantus Land slang for your daily thread. (A "condo" is where a cat lives and where we can visit. It makes much more sense to visit a condo than to visit a thread.) We open one condo per cat per day. There can be lots of posts within your condo -- they are unlimited. You just don't want to have multiple threads going on. It's easier if all of the information from the day is in one spot.

With regard to nadir, in a perfect world, every cat on Lantus would have their nadir at +6. Since cats have minds of their own, the nadir can occur at pretty much any time and as soon as you figure out where your cat's nadir is, it will change. It's not a fixed point. The nadir, on average, may be at a particular time but there are any number of factors that can affect where the lowest point in the cycle falls. If you look at Gabby's SS, her nadir is usually at around +4. However, she's hit lows as early as +1 and as late as +7. The idea is in the beginning, to test at +3, +6 and +9 so you get an idea of where Lantus onset and nadir fall and how much duration you're getting from the insulin. If you look in the New to the Group sticky, these terms are all defined.

Lantus is a long-acting insulin. This is why you don't want to base your dose on your pre-shot test values. Instead, you make an adjustment to the dose based on how low the dose brings your cat's BG numbers. If a dose has your cat's nadir at 60, you don't want to increase the dose -- more insulin could drop the numbers even lower. On the other hand, if the lowest point in the cycle is 150 or 250 or 350, etc., you do want to increase.

With people who are new to Lantus, we suggest that you post and ask for help if you get a pre-shot number that's under 150. There are several options if you do get a low pre-shot and we can walk you through those options. As you gather more and more test data on Martha, you will be able to shoot progressively lower numbers. The saying in these parts is, "Shoot low to stay low." but, you need to be data ready to do so.
 
Nadir and pre-shot

So confused still. Let's say, AMPS is 215. I give shot. Then afternoon test (Nadir???) is 165. I don't do anything about that number, but then comes PMPS, which is back up to 215. If the insulin is based on the nadir, 165, she would not get a shot. Right? But according to PMPS, she needs a shot.
Am I making sense, why I am confused?
 
Hi Hosanna,

At one time Racci was getting 4U. She has been able to slowly decrease her amount to a S3U (Skinny 3u) by following the protocol and switching her from dry food to wet food.

When we say the dose is based on the nadir, we mean the dose you give every day. With lantus you do not keep changing the dose for each shot. You keep a record of the bg's and let them accumulate for several cycles so you can get the story of what your cat is doing with the insulin and act on changing the dose once you have a clear picture. The one # will not do that for you. The accumulated #s will.

The nadir is usually midway in the cycle and the lowest point of the cycle. one of the reasons you base your dose on that count is safety so she doesn't go too low. You want to make sure you don't reduce when your cat is getting very low already at the nadir even though she may be high at other times. I hope that's more clear.

Melanie & Racci

BRB. I have to test Racci
 
Re: Nadir and pre-shot

Hosanna said:
So confused still. Let's say, AMPS is 215. I give shot. Then afternoon test (Nadir???) is 165. I don't do anything about that number, but then comes PMPS, which is back up to 215. If the insulin is based on the nadir, 165, she would not get a shot. Right? But according to PMPS, she needs a shot.
Am I making sense, why I am confused?

The value for not giving a shot is based on the preshot value. The dose is based on the nadir value.
Liz
 
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