Low PMPS - Need Help Please! Shoot or No

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Nanaskitty

Nanaskitty

Member Since 2015
Hello - Our kitty was diagnosed at the end of Feb. 2015 with diabetes. She is on a FF classic diet. Her Lantus dose started at 1 unit 2x daily and she has been to the vets for curves weekly with them always up and down. The vet had changed her dose to 2 units 2x daily for a week, then 2 units AM and 1unit PM for two weeks. The last curve 4/1 her BG was down to 40-160. The vet put her back on 1 unit 2x daily. We started BG testing yesterday and set up a SS for her (the vet told us not to use human monitor and wait to start until she was regulated, which I couldn't wait for after the low numbers). Today I decided to try my own curve to compare with the one she is scheduled to have at the vets tomorrow. She started at 357 this AM and I reduced her insulin to 1/2 unit instead of the full 1 unit (she didn't get insulin last night because she was at 108 pre-shot, and I was uncomfortable shooting under 200). She is now down to 52 and I'm getting nervous. She did hypo mildly after her 2nd dose ever of the Lantus. I gave her a little food and will test again shortly. Any thoughts on her dosing history and numbers today? Thanks
 
Glad to see that you are testing at home. I had a similar situation with Sammy, where the vet recommended a specific treatment plan that conflicted with the protocols provided on this board. I can tell you from experience that I got a lot better advice here on this board than I did from the vet. Nothing against the vet, but they just don't see enough cases to really know the best treatment plan.

It looks like you made a good decision to decrease the dose this morning. Did you recently switch Bananas from a dry food diet to FF, or has she been on FF classic all along?

Based on the limited data on the spreadsheet, it looks like Bananas's time on insulin may be short lived. I would keep testing and providing insulin support, but be sure to follow your gut as you did this morning, if PS is lower than you want to shoot hold off and ask for advice before feeding or shooting.
 
We switched her to FF a few days before she started her insulin. Before that she was eating canned friskies and dry. She is not allowed any dry now, just the can FF. We have gotten very frazzled with the vet. I know diabetes takes time to figure dosing and such, but one week we would get one course of action, the next week something else. Sometimes I don't feel we are being listened to. I'm very glad to have found this forum. I have learned so much in a short time. She just had some food (she's a grazer) and was cleaning herself. Hopefully she doesn't go down much more. Thanks!
 
Removing dry food entirely could totally change the BG. You might find that that simple change is all that Bananas needed. Let's see what tonight's PS is before you make a decision on dosing, but I would think that if she continues to rise from the 103 you should be okay to at least shoot the .5u. You might still need to monitor into the night to make sure that she doesn't go too low though.

If you get to PMPS and are nervous about shooting, don't feed come here for advice before giving insulin or providing food. Whoever is around at that time will be able to help you determine the best course of action.
 
What I wonder about is the huge increases and decreases. Since lantus is a depot drug it builds up in the system. By changing in l unit increments up and down I think it will be very hard to find the correct dose. You need to get enough cycles at the same dose to know if it is working. Then if a decrease is in order it can take several cycles for the depot to be used up. I think you were wise to cut it to .50 and maybe it would be good to try that dose twice a day and see what happens. I'm sure some dosing advisors will be on to help sort it all out. Do you have a hypo kit or the necessary items should she drop under 50?

I also think you were wise to do your own curve at home. They can run high from the stress of going to the vet and being in a cage or some actually go low. My Max is a mild mannered kitty who got labeled aggressive at the vet's during his first curve. My vet left early and he was under the care of another who didn't know him. Apparently he gets cage fever.

Keep posting and asking questions and you will learn the best way to hopefully get this all figured out quickly.
 
After reading on here, we also wondered why our vet chose to increase the dosing so quickly. I do not have any of her exact numbers from the curves done at the vets, but will ask for them tomorrow when we go. When she was first diagnosed she was taken in for a UTI. She received antibiotics and they said at that point her BG was 514. They did a fructosamine and that was at 671. She has never has ketones. We thought originally that her recent behavior (increased thirst, urinating more, slight weight loss and refusal to eat her dry food) was due to the UTI. Her symptoms were the same as when she had one 4 years ago. Two 1 unit doses and she started trembling and was wobbly when she walked. We started karo and brought her right to the vet. By the time we go there, her BG was 316, and a different vet than the one she normally sees saw her. She said it could have been hypo, but with her number she was unsure. Bananas hates leaving the house. Every time we have to take her to the vets, she trembles. She hates dogs and generally refuses to eat there. After the first curve, done the day after her hypo incident her numbers had come down but only to the 300-400 range, but she had only received 2 doses of the Lantus and none the night before the curve. The vet upped the dose to 2units 2x daily and her reasoning was that she felt the 1 unit ( after only 2 injections) was not working. The next week she went in again for a curve and her numbers were down more 200-300 range and the vet was still not happy. She basically tried to blame us for possibly changing her food, which we didn't. I've been very careful with what she eats and how much she gets every day. The dose was then changed to 2 units AM and 1 unit PM for two weeks. Each time we went there we asked about home testing and was told not yet. The last curve her numbers even with stress were 40-160. We were asked to bring her back the next day for just a BG check, but were told not to give her insulin the night we brought her home from the curve or the next morning, so she missed two doses. That reading ended up being 334. Dose went back to 1 unit 2x daily. Since then I found this forum and have done so much research. I wish we knew what we do now weeks ago. We are currently in for a little over $3000.00. I'm sure tomorrow will be a treat when we are armed with much more info at the vets.
 
Hi, and welcome,
As the others have said, it is important to know that Lantus is a "depot" insulin that leaves a reserve (we call it the "shed") of itself in the body. It takes a few days to build this shed (which roughly corresponds to the size of the dose). Every time the dose is raised or lowered, it takes a few cycles for the shed to re-calibrate. That's why we make changes in dose by small increases (.25 of a unit) and why we wait the required number of cycles (usually 6 cycles--3 days) before evaluating how the dose is working. By using this approach we can observe when the kitty reaches the optimal dose and we don't pass the best dose (too much insulin can produce high numbers very much like too little does). When you (or your vet) raise and lower the dose by larger amounts of insulin and jump around in dose, the "shed" never gets a chance to settle in. Lantus likes consistency. I agree that you should settle on a dose that seems appropriate and give it a chance to work. Many vets learned about feline diabetes in the years before the newer, depot insulins like Lantus (and Levemir). Therefore they dose it the way they learned on the older insulins. That approach doesn't work well for Lantus.

Good luck with Bananas!

Ella & Rusty
 
I am so sorry that you have received these instructions from the vets. Now that you have researched and know that lanus is a depot drug and takes time to build up, why are you going back to the vet tomorrow? When I first joined this forum I was shocked that I was getting such different advice from my vet and he does know how lantus works. We started but I wasn't home testing due to my not understanding the importance, fear after the horrible curve at the vet's and my mom being in the hospital. My vet had me back in 5 or 7 days at first at nadir. When Max was at 60 and I wasn't testing he wondered if Max was going into remission so after about 6 weeks on we stopped. Big mistake but necessary because I wasn't able to test enough. After 3 weeks he was back on.

Doing as your vet has ordered hasn't worked well, has it? If I were in your shoes I would skip the vet visit and give the protocol a try or go, listen, and then decide what makes more sense to you. Doubling the dose after 2 days shows to me a lack of understanding. It took awhile for me to understand that people advising here have much more experience than my vet who is wonderful and an IM Diplomat. I send him a spreadsheet and see him for other issues that come up. He told me that he hasn't seen much better regulated cats and doesn't feel the need to get too involved with Max's BG. I'm not telling you not to listen to your vet but to give the protocol a shot. If you feel comfortable you could bring it to the visit tomorrow. I hope I haven't upset you because my intent is to do the opposite.
 
I agree with Elise...unless you really need to see the vet tomorrow, I think I'd just continue with your home testing and let the people here guide you. Our first vet told me China would need to be on at least 4 units twice a day (she's never needed more than 1.75)

The people here have years of experience with Lantus...Real life, 24 hour a day experience so they know what they're doing....and our number 1 rule here is to keep Banana's safe!

I'd continue with the .5 every 12 hours and see how she does. If she's below 150 tonight, I'd "stall", DON'T feed, and post here so someone can be keeping an eye on you tonight. Edit your subject line to say something like "Low PS---Need help!!" so it shows you need some help soon

I LOVE that name!! You just have to tell us how you ended up with a cat named "Bananas!"
 
No, you did not offend. In fact, it just makes me more upset that we have been what I feel mislead in her care and treatment and it has put her in a very dangerous situation. Basically going tomorrow to lay everything out and see what she has to say. My plan was to bring info I found here and the results from the past couple of days and present them. Our minds are already made up. At this point we will be doing it our way, no more weekly visits unless there is an issue or for other instances. It is way too stressful on her and just gets us no where. No, the way it has been going is clearly not working-agreed. As I said, I wish I would have found this forum before this past weekend, It would have saved a lot of stress on Bananas and us. I do appreciate all of the advice given. Before her diagnosis, I had never even heard of diabetes in cats, never mind how to treat it. I do agree that there are a ton of helpful and more knowledgeable people here than we have been dealing with. I never thought that I would be able to give insulin or do home BG testing, but it has been much easier that I expected. I do thank you. Sometimes you need someone to show you what is right in front of you and give you the confidence to do something about it. I will check in later with her pmps.
 
Ah, her name... We took her in from a really bad situation when my daughter was young. Her original name was Banas, but my daughter couldn't pronounce it and always called her Bananas and it stuck. She was supposedly a pet that a friend had taken for a friend and now they couldn't keep her anymore. When we arrived to pick her up, it was a puppy mill type place with animals and mess everywhere. She was very thin and she is a big bodied cat for a female and full of fleas! This is also where her fear of dogs and travel came from. She is a bit "bananas" when she feel well though. Although her name should of been grace, as she really lacks some. She is like a bull in a china shop.

At her last BG test she had gone up to 110. I'm going to test again shortly. I will definitely check in again later. Thank you and definitely no hard feeling. I appreciate everything and want to do what is best.
 
Checking in... pmps at 148. My thought is not to shoot tonight and continue on with .5 units in AM. She has a history of going low. Opinions appreciated. Thank you!
 
How much can you monitor her tonight? Do you have high carb food and a supply of test strips? One option is to wait 1/2 hour, without feeding, and test again. If she's up some, you could probably go ahead with the 0.5U dose.

On this forum, we suggest that the first time you get an under 150 number you post for help, do not feed, and someone can help you through the options. Stalling and testing again is one option.
 
I'm not sure honestly how much I can monitor tonight. I was up with her often last night and am tired. Since getting her diagnosis she tends to sleep most of the day and feels that we should all be up with her when she meows at you at night. I do have test strips. Need to get more high carb food in the am, but I do have karo. Right now she is sleeping after I tested her.
 
She has eaten about 1/4 can of fancy feast. We had a meeting at school and I left her food down before we left, because I didn't know if we would be back in time to feed before insulin if she needed it.
 
You can skip tonight if you want to. She'll likely be higher again in the morning. If you can't monitor tonight, skipping may be the best option.
 
Thank you! I let it go tonight, but when she comes to wake me for her night time adventures, I'll test again. By the way, cancelled our vet curve for tomorrow. Vet is supposed to call so we can discuss home tests and further check ups when necessary. Hopefully we can do this with advise and support from here! Thank you again!
 
Skipping tonight will also drain the depot from the 1.0 unit dose you gave the other day, which could have influenced the lower numbers today. So you should be able to start fresh with the 0.5U tomorrow morning.

Testing at home is so much easier on the cats (and our pocketbook!).
 
I thought it would be really hard to do the ear prick based on some stries, but she has been very cooperative with me poking her all day. This will save her so much stress and will give more accurate numbers to go by to hopefully get her regulated. The $200.00 weekly will be able to go for more testing supplies and food. I just hope the vet will work with us and still fill her prescriptions. It will be nice to start over and get her on a regular routine. Thank you so much!
 
I wanted to add my welcome to Lantus/Lev Land! Bananas is looking pretty good!

As far as the vet goes - one thing we've learned here is that many vets don't have that much experience with the dosing of the long-lasting insulins like Lantus and Levemir. They know that those are good for cats, but the dosing is very different than the older style of insulins. With the older faster-acting insulins, the dose was adjusted based upon the preshot number, then the insulin was working pretty much within minutes after you shot and was out of the body a few hours later.

With the depot insulins, a cat doesn't need to eat at the same time as they are getting their shot. As long as they are likely to eat, ie, not sick, the insulin isn't going to onset (become active) for about 2 hours with Lantus and about 4 hours with Levemir, for the average cat. So you are essentially shooting a number a few hours away.

The other major difference is the depot action - that's pretty important to understand. There is a great description of it in the yellow sticky called "Lantus & Levemir: What is the Insulin Depot?" - look for the link in that on the difference between Lantus and Levemir. You can find that the top section of the post "Where Can I Find It?" which is basically a table of contents to the info in this insulin support group. The bottom section of that post has links on various topics - you probably don't need those yet.

Lantus dosing is also based upon the low point of the cycle, the nadir, which in some cats is +6, but in many cats is not. The nadir can also move around from one cycle to the next.

If your vet is good otherwise, don't be too hard on them about their lack of understanding of how the dosing works. It's really, really common. As long as you can work with them otherwise, you might want to stay with them. It's not that likely that another vet would know more about dosing. These really are newer insulins and they work differently. So many people euthanize their cats upon diagnosis that i doubt most vets even have the opportunity to learn how the insulins work.

The good news is that you've found FDMB and we do understand it. Many people just get their dosing advice here but continue to see their vet for everything else.

Keep asking questions and it will all get a lot easier as you understand more.
 
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