Lola checking in
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Lisa and Witn (GA)
Member Since 2009
I think you need to decrease it. You had a significant increase between 12/2 and 12/26. You increased from .25 to 2 units. That is a major increase in such a short period. You were getting excellent BG readings at .25. Why did you increase it?
It looks like your may be dealing with Somogyi rebound. What this means is because your cat is getting too much insulin, your cat's body is releasing extra glucose and the BG levels are increasing in order to prevent your cat from becoming hypoglycemia. This can only work for so long, eventually your cat will hypo.
My suggestion is that you drop your dose back to .25. If an increase is needed, you only increase it by .25 units and must wait at least one week before increases to determine if it really is needed. You cannot determine if a increase is needed by one BG reading.
It looks like your may be dealing with Somogyi rebound. What this means is because your cat is getting too much insulin, your cat's body is releasing extra glucose and the BG levels are increasing in order to prevent your cat from becoming hypoglycemia. This can only work for so long, eventually your cat will hypo.
My suggestion is that you drop your dose back to .25. If an increase is needed, you only increase it by .25 units and must wait at least one week before increases to determine if it really is needed. You cannot determine if a increase is needed by one BG reading.
lolacat00
Member Since 2013
We started to increase when her numbers were going from low blues to high blues. Yes we understand initially we increased too fast, at the time we were not informed. Please understand we are new to this - our cat was just diagnosed in October and we really are trying to do the best we can.
We were previously told to stay at a dose for a minimum of 3-5 days or 6-10 cycles. That is what we have been following. Now we should wait "at least one week"?
We were previously told to stay at a dose for a minimum of 3-5 days or 6-10 cycles. That is what we have been following. Now we should wait "at least one week"?
BJM
Member Since 2010
If you zoom out the view of your spreadsheet, you'll see that the colors shift from green to blue to yellow and so on, as you started increasing the dose. This suggests that a re-start of 0.25 (and it takes 5-7 days for the depot to drain) may allow you to find a more functional dose. Optimal glucose control is from 50 to 130 mg/dL most of the day.
While you do this, please check for urine ketones (and maybe glucose too, to see if the renal threshold is exceeded at all). There are some tips in my signature link Secondary Monitoring Tools.
While you do this, please check for urine ketones (and maybe glucose too, to see if the renal threshold is exceeded at all). There are some tips in my signature link Secondary Monitoring Tools.
Lisa and Witn (GA)
Member Since 2009
Looking at your spreadsheet, you were getting excellent readings at .25. Anything below 200 at preshot are great numbers for a cat on insulin. Generally for newbies, we use 200 as the don't shoot number until they become familiar with how their cat responds to the insulin dose.
We recommend one week between dose changes to give the cat's body sufficient time to adjust to a dose change. Three days is definitely too short between dose changes.
There is a little bit of a learning curve with managing FD, but one advantage, is that you usually can start over. Just remember "Start low and go slow". That is always good advice to follow with FD. Don't worry, before long, you will be offering advice to new newbies.
We recommend one week between dose changes to give the cat's body sufficient time to adjust to a dose change. Three days is definitely too short between dose changes.
There is a little bit of a learning curve with managing FD, but one advantage, is that you usually can start over. Just remember "Start low and go slow". That is always good advice to follow with FD. Don't worry, before long, you will be offering advice to new newbies.
Deb & Wink
Member Since 2013
There are 2 dosing protocols we use here when people are using Lantus or Levimir insulins. One method, the Start Low, Go Slow protocol (SLGS) does dose changes in weekly intervals, unless you see a sudden drop below 50 mg/dL on a human meter. The other method, Tight Regulation or TR holds the dose for a minimum of 3 days or 6 cycles before a dose change, unless you see the same type of low numbers.
Since there are 2 different methods for dosing and making changes in the dose with Lantus, you are getting different opinions on the dose changes and how long to hold them.
It's really up to you, as to which method you want to use.
I do think that holding at the reduced dose of 0.25U for now will give the depot time to drain and we will start to see those nice blue numbers again.
Anything else going on health wise with Lola right now? Infection? Inflammation?
Since there are 2 different methods for dosing and making changes in the dose with Lantus, you are getting different opinions on the dose changes and how long to hold them.
It's really up to you, as to which method you want to use.
I do think that holding at the reduced dose of 0.25U for now will give the depot time to drain and we will start to see those nice blue numbers again.
Anything else going on health wise with Lola right now? Infection? Inflammation?
lolacat00
Member Since 2013
The last two vet visits (11/16, 12/7) came back with no signs of illness or infection. But Lola's BG's have been high for over a month now and she is definitely starting to show signs of uncontrolled diabetes. She is drinking/peeing much more. She is acting lethargic and a ketones test yesterday resulted in trace amounts.
She's been on .25u for 14 cycles without significant improvement. After a few days things looked a little bit better (we even got a 200 reading one night) but the last couple days we are getting readings in the 300's again. We are going to increase to 0.5 per the protocol. If things don't start improving immediately it looks like she'll be going back in to the vet. It's very frustrating and I feel so bad for her.
-Rachael
She's been on .25u for 14 cycles without significant improvement. After a few days things looked a little bit better (we even got a 200 reading one night) but the last couple days we are getting readings in the 300's again. We are going to increase to 0.5 per the protocol. If things don't start improving immediately it looks like she'll be going back in to the vet. It's very frustrating and I feel so bad for her.
-Rachael
BJM
Member Since 2010
Go with the gradual increases with a minimum of 6 shot cycles (for Tight Reg) between dose adjustments. It definitely can tax one's patience!
Get tests in the +5 to +7 range to check how low the glucose is going. You want it above 50 mg/dL on a human glucometer or 80 mg/dL on a pet-specific glucometer.
Get tests in the +5 to +7 range to check how low the glucose is going. You want it above 50 mg/dL on a human glucometer or 80 mg/dL on a pet-specific glucometer.
Wendy&Tiggy(GA)
Member Since 2011
I think you need to stick more closely to the protocol like BJ says - don't hold a dose too long if its not working. You could go over to the lantus forum and post there for help on a regular basis - they will keep you straight on when to dose and how much..
There is no rush to post there. 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.
http://www.felinediabetes.com/FDMB/viewforum.php?f=9
There is no way she is getting into contraband ?
Wendy
There is no rush to post there. 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.
http://www.felinediabetes.com/FDMB/viewforum.php?f=9
There is no way she is getting into contraband ?
Wendy
lolacat00
Member Since 2013
We have everything locked down in terms of contraband. +5 though +7 testing is so difficult during the weekdays for us. We got some extra testing in during the holidays, but usually on weekdays we do an AMPS, +2, PMPS, and a +4 before bed. Maybe we need to start waking up at midnight to test. Daytime nadir testing during the work week isn't an option.
Based on the data we have, I'm fairly confident right now she's not dipping too low at nadir and that an increase is warranted, even though we don't have any nadir readings over the past few days. I could stay up and get a nighttime nadir tonight, and increase based on that. I don't want to get in trouble for increasing a dose based on only one nadir reading, but she's been on .50 for 8 cycles now and it sounds like its time to bump her up.
-Rachael
Based on the data we have, I'm fairly confident right now she's not dipping too low at nadir and that an increase is warranted, even though we don't have any nadir readings over the past few days. I could stay up and get a nighttime nadir tonight, and increase based on that. I don't want to get in trouble for increasing a dose based on only one nadir reading, but she's been on .50 for 8 cycles now and it sounds like its time to bump her up.
-Rachael
Deb & Wink
Member Since 2013
Yes, most of us that work don't live close enough to get home during the day to test.
Yes, I think that based on your readings on your SS, you can easily bump that dose up from 0.5U t0 0.75U. We want to see some lower blue numbers at least.
Come on Lola! Give us some Blues!
lolacat00
Member Since 2013
Took Lola to the vet today (a new vet). Lola was slightly dehydrated and has blood and ketones in her urine. A urine culture is being done.
The vet seemed well informed on feline diabetes (based on what we've learned here) and said she's had success getting cats in remission. But didn't completely agree with the protocol we've been using, and was not impressed that we had been dosing our cat based on "laypersons" advice (not surprising coming from a vet, i guess).
-She was pretty adamant about home testing with an alphatrak. I don't think she trusts our numbers on the human meter, although she stated she agrees with that home test curves are more accurate. We agreed to run an alphatrak blood curve at her office on Tuesday as long as it's compared with our meter for comparison purposes. She thought it was a good idea and is giving us a discount on the curve.
-She believes a dose should be kept at least one week. She also doesn't seem to think such small incremental dose changes are necessary. She wants to bump Lola up to 2u now. We agreed to wait til Tuesday after the blood curve before any decisions are made. I honestly don't know what we will end up doing.
-When her urine came back with blood indicating a possible (probable?) bladder infection, I said I was hopeful that once the infection was treated her blood sugar would come back down without necessarily needed a large dose increase. I don't think she was convinced of this, but said she understood what i meant. Once the culture comes back, the vet stated we will treat with the proper antibiotics if necessary which typically run a 2-4 week course.
Today she received sub-q fluids for slight dehydration and a standard blood panel. Blood work looked good - BG was 375 on the blood panel at noon.
I'm pretty stressed out today, mostly because we are just trying to do what's best for Lola and constantly getting different advice from different sources. And also stressed that she's been living with what appears to be a bladder infection for weeks (if her BG levels are any indication) and our previous vet didn't catch this. Anyways...that's the update.
The vet seemed well informed on feline diabetes (based on what we've learned here) and said she's had success getting cats in remission. But didn't completely agree with the protocol we've been using, and was not impressed that we had been dosing our cat based on "laypersons" advice (not surprising coming from a vet, i guess).
-She was pretty adamant about home testing with an alphatrak. I don't think she trusts our numbers on the human meter, although she stated she agrees with that home test curves are more accurate. We agreed to run an alphatrak blood curve at her office on Tuesday as long as it's compared with our meter for comparison purposes. She thought it was a good idea and is giving us a discount on the curve.
-She believes a dose should be kept at least one week. She also doesn't seem to think such small incremental dose changes are necessary. She wants to bump Lola up to 2u now. We agreed to wait til Tuesday after the blood curve before any decisions are made. I honestly don't know what we will end up doing.
-When her urine came back with blood indicating a possible (probable?) bladder infection, I said I was hopeful that once the infection was treated her blood sugar would come back down without necessarily needed a large dose increase. I don't think she was convinced of this, but said she understood what i meant. Once the culture comes back, the vet stated we will treat with the proper antibiotics if necessary which typically run a 2-4 week course.
Today she received sub-q fluids for slight dehydration and a standard blood panel. Blood work looked good - BG was 375 on the blood panel at noon.
I'm pretty stressed out today, mostly because we are just trying to do what's best for Lola and constantly getting different advice from different sources. And also stressed that she's been living with what appears to be a bladder infection for weeks (if her BG levels are any indication) and our previous vet didn't catch this. Anyways...that's the update.
Deb & Wink
Member Since 2013
So are they doing to test the exact same blood drop on an Alphatrak and then on your meter? Is that the comparison they are doing?
Here are some reference ranges that member BJM put together. It gives the different values for human meters versus pet specific like the Alphatrak.
Reference ranges for decision making
[Glucose reference ranges are unsubstantiated and have been removed by Moderator]
* * * * * * * * * * * * * * *
How to use the glucose reference values chart:
When you get a test, look for the number on the chart that either equals, or contains, the test value you have. Read the information. As needed, make a decision and act.
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.) [/quote]
Becky and Toby
Member Since 2013
How is Lola doing today?
I know it's tempting to follow all vet advice - I did for months, even with my Toby having some pretty serious hypos - but please remember that feline diabetes is just one illness out of so many that vets need to know, for one species out of many that they treat. They don't know everything there is to know, and you absolutely shouldn't do anything that you're not comfortable with.
That said, I'm glad that you've found a vet who sounds more informed than many others.
Lola has been well regulated before, hasn't she? Hopefully getting this infection under control will allow her to be again. The best of luck to both of you :smile:
I know it's tempting to follow all vet advice - I did for months, even with my Toby having some pretty serious hypos - but please remember that feline diabetes is just one illness out of so many that vets need to know, for one species out of many that they treat. They don't know everything there is to know, and you absolutely shouldn't do anything that you're not comfortable with.
That said, I'm glad that you've found a vet who sounds more informed than many others.
Lola has been well regulated before, hasn't she? Hopefully getting this infection under control will allow her to be again. The best of luck to both of you :smile:
Deb & Wink
Member Since 2013
Keep a close eye on those ketones. Anything more than a trace, is cause for an immediate visit to the vet.
Are you urine testing at home for the ketones with the ketodiastix?
Did the vet say what the ketone level was during the office visit?
I think it's time for another dose increase too. At least up to 1.25U.
Are you urine testing at home for the ketones with the ketodiastix?
Did the vet say what the ketone level was during the office visit?
I think it's time for another dose increase too. At least up to 1.25U.
lolacat00
Member Since 2013
Deb & Wink said:
Yes
Deb & Wink said:
Yes she's been showing small ketone levels with at home urine testing, and showed small levels at the vet yesterday.
Becky: She's doing okay for now, just want to get those numbers down before another DKA episode. She was well regulated until the beginning of December and her numbers have been elevated since. We took her to the vet 12/7 (who said she was healthy), but now I'm thinking she may have just had a bladder infection this whole time? If that's the case I am hoping that treating it will fix the problem and maybe she really doesn't need more insulin. I don't think the vet will agree and am certain she wants her insulin up to at least 2u. I am not dead set against raising her to 2 units but want to talk more with the vet about a plan.
I'm really hoping we can work with this new vet. This is the fourth clinic since October that we've been to. How do you maintain a positive relationship with your vet and at the same time go against the treatment they are prescribing?
Wendy&Tiggy(GA)
Member Since 2011
Don't tell them 
It could well be the bladder infection causing the issue - any infection can spike BG. With antibiotics hopefully you will see a difference in a few days.
What kind of wellness are you feeding?
If anything I would take her to 1.25. She has been on 1unit long enough and is flat yellow.
Wendy
It could well be the bladder infection causing the issue - any infection can spike BG. With antibiotics hopefully you will see a difference in a few days.
What kind of wellness are you feeding?
If anything I would take her to 1.25. She has been on 1unit long enough and is flat yellow.
Wendy
Wendy&Tiggy(GA)
Member Since 2011
the cans marked grain free?
Wendy&Tiggy(GA)
Member Since 2011
ok good then lets hope things settle once the infection is gone!
Deb & Wink
Member Since 2013
The Wellness grain free foods are a nice low carb percentage for our diabetic cats.
I agree with Wendy, to up the dose to at least 1.25U. ( Said this in my earlier reply to you.)
Keep a close eye on those ketones.
Make sure your Lola is getting enough water in her food. That can help to flush out the excess ketones.
You can even add more water to the canned food to help her out. Make the food sort of applesauce consistency to even soupy.
ETA: Would you please add the DKA survivor to your signature? So that we can be aware of that and make sure to take that into account when we make suggestions.
I agree with Wendy, to up the dose to at least 1.25U. ( Said this in my earlier reply to you.)
Keep a close eye on those ketones.
Make sure your Lola is getting enough water in her food. That can help to flush out the excess ketones.
You can even add more water to the canned food to help her out. Make the food sort of applesauce consistency to even soupy.
ETA: Would you please add the DKA survivor to your signature? So that we can be aware of that and make sure to take that into account when we make suggestions.
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