Mario is not doing good

Please look at the yellow info stickies at the top of the list of thread titles in this forum to get an idea of how Lantus works and the dosing methods that are used here. Ask a ton of questions. :)
 
Hello and welcome. On your post on the Feline Health Forum, Kris pointed out a couple of important things. First, always get a test before every shot, that's both AM and PM each and every day. You don't want to give insulin if his numbers are too low to do so. Second, there is data only the first quarter of the day on the spreadsheet. Cats notoriusly go lower at night. We determine how to change the Lantus dose based on how low it takes the cat, therefore that PM data is very important. It would really help us see what is happening if you could get a test every night just before you go to bed. And the third thing for now, because of the effects of the Lantus depot, we like to hold our doses longer. Take a look at the Sticky Notes on Tight Regulation and the Start Low Go Slow Method to see which method you'd like to follow. With our help and following the dosing methods, we can can get Mario better regulated.

How about helping us by doing a little experiment. Shoot 5.5 units in both the AM and PM for the next three days. Get a preshot test before each shot, and try to get a test somewhere in the middle of each cycle, both AM and PM. Keep posting here. If you see a number below 90, post here and ask for advice on what to do with the dose.
 
Hi. I'm not one of the experienced and seasoned advisors on this board, but all of us here can tell you that if you can start working the program for Mario, he will do better.

I would start by getting Mario on a 12 hour cycle. You mentioned that he gets shots during a range of times. I know it's hard - we ALL know it's hard - but if you can develop a schedule and stick to it as best you can, you will start to regularize his glucose levels. Shooting 15 minutes early is equivalent to a dose increase, and late is a decrease.

As Wendy mentioned, getting mid-cycle readings is imperative. We see a lot of +1-+3 readings each cycle, but nothing after. All cats are different, but Lantus typically shows a nadir between +4 and +7. Dose changes are based on those nadir numbers, not the pre-shot. Pre-shot is only a measure of whether it's safe to shoot.

If you could decide whether you want to use the SLGS or the tight regulation method, that would also help with dosing advice.

In your info line, please give us an idea of what Mario eats. Is he still on dry food? Are you feeding a low carb food, and if so, what? Are there any other medical issues? Many of us have kitties that have additional chronic illnesses, and knowing that would help.

Take a look at the signature lines of other users on the board to see what sort of information we provide. A diagnosis date is common, with the type of food, meter, and when you started with insulin.

This seems overwhelming at first. It's okay. You love your Mario, and you can do this. With help and support, you will get the numbers to a reasonable point, and see wonderful changes in his appetite and energy levels. Keep posting.

Each day, start one post with Mario's name, the date, and the pre-shot numbers labeled "AMPS" if you shoot. Each test you do after that will be numbered - +1 =+11. The evening number is PMPS, and etc. If you want an experienced person to take a look at the numbers, add the question mark to the title.

Read all the stickies on how to do this. Then, read them again. They help a lot. They'll help you figure out when a dose increase is indicated, and what to do for hypoglycemia. Know the signs of hypo, and have materials on hand to take care of it.

Take care of yourself, too. Get sleep when you can, and know that the goal is either stabilization or remission. It can be done.
 
Welcome to the Lantus/Lev board!

You're probably going to hear several of us echo the same information. Sorry if it's repetitive. However, Lantus (and Lev) are different from most of the other types of insulin. If your vet isn't terribly familiar with a depot-type of insulin like Lantus or what you've been reading is geared to your using shorter acting types of insulin, Mario isn't going to benefit from the ways that Lantus works best.

As several people have noted, you need more information before you conclude that Mario isn't doing well. If you look at people's spreadsheets here, you'll see that we're very data driven. We test every day and test several times a day. Yes, this takes dedication. However, testing is the best and only way to keep your kitty safe. When you're seeing those high numbers, you don't know what's happened either the previous evening or even on those days when you don't have test data. When a cat's numbers drop into a range lower than what the kitty is used to, often numbers bounce into a higher range for several cycles. Not having the information that tells you what's going on means you may end up increasing a dose when a missed low number would signal the need for a dose reduction. The bottom line is that we encourage everyone to always test before you shoot and to get at the bare minimum, one test during both the AM and PM cycles.

Lantus likes consistency. This is due to Lantus being a depot-type of insulin. Every time you change a dose, it has an effect on the depot. One way of maintaining consistency is to give the same amount of insulin at AM and PM shot times (unless it's time for a dose reduction or increase). If you shift the dose at each shot time or before the depot has a chance to stabilize, generally you get wonky numbers. In addition, Lantus dosing is based on the lowest number in the cycle (i.e., the "nadir"). For most cats, the nadir is around the middle of the cycle. It is important to devote some time when you test every 2 or 3 hours over a 12-hour period (this is called a "curve") in order to better understand where your cat's nadir is. (Not all cats have their nadirs at +6. My kitty, for example, had an early nadir -- around +3.) Knowing how your cat responds to Lantus is essential for diabetes management. Right now, you don't know where Mario's nadir falls nor do you know how low his numbers are going.

To the best you can, giving shots as close to every 12 hours is also a matter of consistency. Because Lantus is long-acting and because of the depot, the closer to shooting every 12-hours you can be, will yield the best results. An early shot acts like a dose increase whereas a late shot acts like a dose reduction.

Please let us know if you have questions. The people here are very generous with their knowledge and time. We're here to help.

 
Oh, and one other thing about your vet.

You may have a fantastic vet helping you with your cat. Many of us have struggled, though, with vets who don't understand feline diets or how to treat and control diabetes. Every vet I have consulted about my Yemala has been surprised that we got her into remission, and it's been veterinarian error that took her out of remission two times.

The first vet to diagnose Mala in 2006 told us to shoot 7u of Vetsulin twice per day, and that we'd be lucky if she survived for 2 years. Mala is now 19 years old, and she may be going into remission a third time.

Vets are important, but you may find that you'll have to educate them as you go. Low carb food is a great start, but it's important that you consider which will be best for Mario as you go. Lisa Pierson, the patron saint of this board, has linked a list of all commercial wet cat food with their nutritional values, carbs, fat, and phosphates. It's in the sticky at the top of this board. Consider looking up the food you're giving and make sure it's a safe one.

To recap, get a regular schedule for Mario, test more often and post regularly, and stabilize his dose. Please look at the spread sheets for others on this board, and you'll see about how much we test and how much data we gather.

Oh, and if you are concerned about the cost of test strips, you might consider switching to a human meter. Relion meters, sold in WalMarts, offer less expensive strips than those for cats. We are currently using a meter from CVS, and the strips are even less expensive. Put in a supply and use them. They are your best tool, other than Lantus, in controlling Mario's levels.

Please ask questions. We want Mario healthy and you less stressed. You can do this.
 
Wendy&Neko said:
Hello and welcome. On your post on the Feline Health Forum, Kris pointed out a couple of important things. First, always get a test before every shot, that's both AM and PM each and every day. You don't want to give insulin if his numbers are too low to do so. Second, there is data only the first quarter of the day on the spreadsheet. Cats notoriusly go lower at night. We determine how to change the Lantus dose based on how low it takes the cat, therefore that PM data is very important. It would really help us see what is happening if you could get a test every night just before you go to bed. And the third thing for now, because of the effects of the Lantus depot, we like to hold our doses longer. Take a look at the Sticky Notes on Tight Regulation and the Start Low Go Slow Method to see which method you'd like to follow. With our help and following the dosing methods, we can can get Mario better regulated.

How about helping us by doing a little experiment. Shoot 5.5 units in both the AM and PM for the next three days. Get a preshot test before each shot, and try to get a test somewhere in the middle of each cycle, both AM and PM. Keep posting here. If you see a number below 90, post here and ask for advice on what to do with the dose.
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Hi!
Thank you so much for your info.

I am testing before feeding him and giving him the insulin. I already tried 5.5 for a long time. Today I started 6.5. I will hold on to that number for 3 days unless the glucose number gets too low.
I wanted to share with you that I give him the insulin around 7:30am and 6:30pm. So, 11 hours in the day and 13 hours at night. Is that OK? I do that because I like to give him the insulin before I feed him dinner. But I can also give him dinner around that time and give him the insulin at 7:30pm. Would that make a difference?
I feed him three times a day. Should I feed him more times? Would that help lowering the glucose?

Thanks so much
Vannessa
 
It is best if you test, feed, and shoot in that order. Most people do that all within 15 minutes. Some people shoot the insulin while kitty is eating. It is also best to try t9 be as close to 12 hours apart as you can. Shooting more than 1/2 hour early or late can 8moact the numbers.

Feeding several smaller meals is easier on their pancreas, same as for human diabetics. Tr6 t9 feed most of the foodnin the first half of the cycle, before nadir. Feeding after nadir can shorten duration and increase preshot numbers.
 
A couple more things. It’ll help us help you and Mario if you keep the spreadsheet up to date. What was his preshot test value this morning?

Also, now that you are shooting more than 6 units, that is the point where we suggest that you get your kitty tested for secondary conditions that can cause a need for higher doses of insulin. My kitty Neko had both acromegaly and IAA or insulin auto antibodies, and her dose got up to 8.75 units. One in four diabetic cats has acromegaly.
 
Wendy&Neko said:
It is best if you test, feed, and shoot in that order. Most people do that all within 15 minutes. Some people shoot the insulin while kitty is eating. It is also best to try t9 be as close to 12 hours apart as you can. Shooting more than 1/2 hour early or late can 8moact the numbers.

Feeding several smaller meals is easier on their pancreas, same as for human diabetics. Tr6 t9 feed most of the foodnin the first half of the cycle, before nadir. Feeding after nadir can shorten duration and increase preshot numbers.
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Wendy&Neko said:
A couple more things. It’ll help us help you and Mario if you keep the spreadsheet up to date. What was his preshot test value this morning?

Also, now that you are shooting more than 6 units, that is the point where we suggest that you get your kitty tested for secondary conditions that can cause a need for higher doses of insulin. My kitty Neko had both acromegaly and IAA or insulin auto antibodies, and her dose got up to 8.75 units. One in four diabetic cats has acromegaly.
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Today’s testing was: 6.5 units - 400 at 7:30am, 257 at 6:30pm, and 321 at 9:30pm I’m so depressed.
 
Vannecheta said:
I’m so depressed.
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I'd be depressed too...however, you're not seeing the full picture - please get the pre-shot test a.m. and p.m. so you'll know exactly where he's at before you give him the insulin. Lantus takes time...please get more tests at night - I'm sure you've already gotten some excellent advice from members here in the L&L group - now it's your turn to take action - get those tests and adjust the insulin accordingly...every day - you need to do this every day - at the same time every day...we're here to help..and there's lots of information and help available!
Welcome aboard!
 
Wendy&Neko said:
It can take several cycles for the depot to fill, meaning you might not see what a dose is capable of until several cycles after an increase. Hang on. :bighug:
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So, I started with 6.5 yesterday morning. When is the soonest I can give him more? I tested this morning and it was 416 . Can it be acromegaly?
 
Right now, I'd be VERY hesitant to give you much advice regarding dose and I'm one of the longest term members here. You just don't have enough data in order for me to be comfortable with giving you suggestions that would be safe for Mario. You need to:
  • Test before each and every shot
  • You need to provide test data on a daily basis
  • You need to do several curves in order to sort out when onset and nadir fall
I realize this may be a lot to ask. However, as noted above, there's no way to know what's going on with Mario since we can't see well over half of your data due to the lack of PM testing and the lack of tests on a daily basis even in the AM. Given the way you were instructed to dose Mario earlier this year, it makes it very difficult to know how your cat was responding to Lantus. I would not focus on a high dose condition until you have more data to inform that idea.

As an example, if you open Gabby's spreadsheet and look at the entry for 11/2/2009, you'll see her AMPS was 429. By +4, she dropped to 47 and by PMPS, she bounced back to 400. Without the spot checks, I would have increased Gabby's dose rather than giving her the dose reduction she warranted. This is what is concerning about the amount of data you have. We have no way to tell if Mario has earned dose reductions with data that doesn't cover when his nadir is likely to be.

In addition, even with the TR Protocol which is more aggressive, dose increases of 0.25u are what's warranted. Unless you have consistent information, I would not increase Mario's dose by more than 0.25u.

You mentioned in your previous thread that you are feeding Mario canned food. What food are you giving him? Not all canned food is low in carbs.

Zobaline will take a month or two to have an effect.
 
Sienne and Gabby (GA) said:
Right now, I'd be VERY hesitant to give you much advice regarding dose and I'm one of the longest term members here. You just don't have enough data in order for me to be comfortable with giving you suggestions that would be safe for Mario. You need to:
  • Test before each and every shot
  • You need to provide test data on a daily basis
  • You need to do several curves in order to sort out when onset and nadir fall
I realize this may be a lot to ask. However, as noted above, there's no way to know what's going on with Mario since we can't see well over half of your data due to the lack of PM testing and the lack of tests on a daily basis even in the AM. Given the way you were instructed to dose Mario earlier this year, it makes it very difficult to know how your cat was responding to Lantus. I would not focus on a high dose condition until you have more data to inform that idea.

As an example, if you open Gabby's spreadsheet and look at the entry for 11/2/2009, you'll see her AMPS was 429. By +4, she dropped to 47 and by PMPS, she bounced back to 400. Without the spot checks, I would have increased Gabby's dose rather than giving her the dose reduction she warranted. This is what is concerning about the amount of data you have. We have no way to tell if Mario has earned dose reductions with data that doesn't cover when his nadir is likely to be.

In addition, even with the TR Protocol which is more aggressive, dose increases of 0.25u are what's warranted. Unless you have consistent information, I would not increase Mario's dose by more than 0.25u.

You mentioned in your previous thread that you are feeding Mario canned food. What food are you giving him? Not all canned food is low in carbs.

Zobaline will take a month or two to have an effect.
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Hi and Thank you for your response.
Maybe I didn’t entry the data correctly but I have done many 12 hour curves and frequently I have check his glucose 3 times a day, for example, at 7:30am, at 1:30pm, and at 6:30pm. If the number at 1:30 is around, let’s say, 200, I doubt that and hour or two before and after would drop dramatically to, let’s say, 60. Am I wrong?
I’m doing a curve today. I will post late tonight the numbers.
Thank you so much for your help. I am open to learn everything I can to help my baby Mario.
 
Vannecheta said:
Hi and Thank you for your response.
Maybe I didn’t entry the data correctly but I have done many 12 hour curves and frequently I have check his glucose 3 times a day, for example, at 7:30am, at 1:30pm, and at 6:30pm. If the number at 1:30 is around, let’s say, 200, I doubt that and hour or two before and after would drop dramatically to, let’s say, 60. Am I wrong?
I’m doing a curve today. I will post late tonight the numbers.
Thank you so much for your help. I am open to learn everything I can to help my baby Mario.
Click to expand...
I’m going to fix the data entry. I think I know what I did wrong
 
In order to get you the advice you need, we strongly recommend that you begin to follow the posting protocol on the FDMB. Start with your signature line. In that space, put in the name of the food you're giving Mario, his diagnosis date, the name of the meter you use, and which kind of insulin you use.

Then, daily, start one new thread. This one is too old and too long. A daily thread will look like this:

Mario 12/23 AMPS 400 +4 200

Update it through the day, but only one thread per day. In the first post of the day, link in the conversation from the previous day, so advice can be consistent across days.

Please look at the way others on this board set this up and follow this method. It really does get you the best advice in the most timely manner.

Putting the numbers into the header allows others to see at a glance where Mario is, rather than having to scroll down into the comments.

Good luck.
 
Vannecheta said:
. If the number at 1:30 is around, let’s say, 200, I doubt that and hour or two before and after would drop dramatically to, let’s say, 60. Am I wrong?.
Click to expand...
Hello and welcome. You’ve gotten a lot of good advice. Just take time to read over and absorb as much as you can. There is so much to learn. And yes, it is possible to be at 200 and drop quickly to a low number. My Gizmo loved to dive from highs to lows. We just don’t know if that is happening without testing to see what is really going on with Mario. When you do a curve, can you test every 2 hours for a 12 hour period? Even every 3 hours would be helpful if you can’t get a test every 2. Then maybe one middle of the night test to help paint the whole picture. I didn’t look at your spreadsheet yet, so if you are already doing this ... sorry for being repetitive.
 
Your spreadsheet makes much more sense now!! The +number is the number of hours past your shot time.

It it still important to get tests during the PM cycle. I think it was Wendy who mentioned that many cats often experience lower numbers during the PM cycle.

I do think Mario is bouncing. If you lookout the numbers from 12/12, Mario started out high, dropped into blue numbers and then bounced back into pinks. His liver and pancreas reacted to the drop by releasing a stored form of glucose along with counterregulatory hormones that cause numbers to rise.

Seeing the AM cycle is helpful. However, as I noted previously, PM tests are just as important. It's also essential that you get tests on a daily basis.
 
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