Max not in remission after all

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tiffmaxee

tiffmaxee

Member Since 2013
After 3 weeks off Lantus we went back to the vet today and his BG was 310 in the vet's and 239 on mine so I'm to start him back in Lantus, .5 unit once a day. I asked about .25 twice and he felt this is better because I bet he feels .25 is hard to give. I explained how I was told to do it but he said to do the once a day. With my situation with my mom it is easier this way but I don't want to hurt Max's chances if remission not upset my vet who really works with me on most issues. Is once a day really bad?

Elise
 
Lantus usually lasts about 12 hours with some overlap, so shooting once a day may not control him very well. If you can reliably measure quarter units, I'd do that.
 
I just tried to measure .25 but gave up. It is too hard. I asked my vet if he had many cats on once a day and he said yes. Half a unit twice a day put him at risk of going hypo.
 
In your other thread, I explained the drop method; have you practiced that yet?

Another option is to switch insulin to a non-depot insulin such as ProZinc which is easier to microdose and has no depot to carry over.
 
I tried to do the drop method this afternoon and got frustrated. 1/4 unit must be just a drop or so? I'll try again later tonight. My vet feels that he might need a very tiny amount or he will go hypo. The fact that there was glucose in his urine was very upsetting to me. I don't have any food coloring here so I tried pouring some soy sauce into water. That is probably the problem. I'll buy some food coloring tomorrow.
 
Thats a shame he isn't in remission - I suspect the insulin was stopped too soon and he wasn't ready. We like numbers to be in normal cat range (40-130) for at least a week before we stop insulin. And we reduce insulin gradually from 0.5 to 0.25 to even 0.1 before stopping. But he may still go into remission so lets see what we can do.

First, Lets get that spreadsheet set up so we can really see whats going on : http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Heres how 0.25 units looks like. http://s214.photobucket.com/user/jillsphotos2/media/Lantus Group/025unit-1.jpg.html. If we get more numbers then we could try 0.5 twice a day depending on how he handles it once a day. Hence the need for the SS!


Wendy
 
Max was given .5 yesterday afternoon but I tried and hopefully succeeded in giving him .25 this morning. My vet had told me to start the once a day dosing at the usual time today even though he got it in the afternoon yesterday. I'll practice some more before tonight's dose. I don't know how I will explain this to my vet. He's a great guy and really cares. I hate to go against his orders. I understand how he feels about the small dose. As I recall it will take a few days to take effect so I will attempt to test him Thursday and Friday and report to my vet the results. Thanks for the encouragement, Wendy. If this dosing doesn't work I guess I might have to change the type of insulin but would hate to if it will give Max less of a chance of remission.

Any comments on the 310 Alpha reading and 239 with the Relion and both done on the same stick yesterday at the vet's office? This is my second meter and I did run a control and that measured 150 or 155 as I recall.

I'm not very computer literate but will try to get the spreadsheet up and running.

Elise
 
A possible work around if you can't measure a smaller dose is to go with carb % calories just a hair higher to offset the twice a day dosing and remain safely above 50 mg/dL.

Ex if you were feeding 5-6 % calories from carboydrates, go to 7-8% calories from carbohydrate. And some cats may do better with the slightly higher carbs. Blood glucose testing will show you how that works for him.
 
Let us know if you need help setting up the spreadsheet and we can set it up for you. at least try and get the google docs account set up and that will be a good start.

I regularly give Bailey 0.25 or less. The trick is practice - get a syringe, a small bowl of food colouring and a white plate or tissue. Then draw it up and see how it looks. Use magnifiers and a bright light if needed. You can practice also rotating and pressing the plunger in a screwing motion to expel one drop at a time. The white tissue will show you the drops and drop size. You can then count how many drops 0.5 is. Then how many drops you need to expel to get to 0.25.

But for 0.25 - I would pull it out to 0.5 and then try and expel some so that it looks like the picture. as long as you get some out then you know its less than 0.5.

Wendy
 
I spoke with my vet and told him that Max's last +6 were high, 270 and 328. He wants me to test a couple more times and call the end of the week rather than raise the insulin dose.
 
Re: the meter discrepancies - those were within the 20% meter variance the FDA allows, plus human glucometers typically read from 30 to 40% lower than pet specific meters.

Are you OK with waiting?

And a thought - is he having a pancreatitis flare?
 
I'm not sure if he is having a pancreatitis flare or not. He is so hard to read these days. He is eating about his same amount BUT that could be due to the diabetes I think. He was crying for food this morning which before diabetes would indicate he isn't having a flare. I just gave him his amlodipine and baby food. He gets his insulin at 8. The lower Nadir was done at 7 hours but he was high yesterday at 6 1/2 hours.

Can I put the strip all the way into the meter, stick, then get the blood if it will take more than 20 seconds for the blood to come to the surface or do I have to wait until I see blood to put the strip into the meter? Thanks.
 
tiffmaxee said:
...Can I put the strip all the way into the meter, stick, then get the blood if it will take more than 20 seconds for the blood to come to the surface or do I have to wait until I see blood to put the strip into the meter? Thanks.
Click to expand...

I put the strip partway in, prick, (optionally get the droplet on my clean fingernail if it is coming out fast and I need to blot), push the strip in, start massaging if I need toget more blood, and suck up the droplet from the fingernail or the ear. All the while snuggling Gracie between my left arm and body, making sweet talk and giving nuggies in between using my right hand.
 
Thanks. I tried it that way and it was better. Before I massaged before putting the strip in the rest of the way and ended up taking too long and not enough blood as some ended up blotted away. Then I had to stick him again, poor guy. So our +6 was 217, better than yesterday. I guess my vet was right not to raise the dose so soon. I cancelled tomorrow's appointment and kept the one for Friday. We will talk Thursday and I will either cancel and reschedule for next Tuesday or so or keep it based on the next tests. As you can see I'm not doing tight regulation so I wasn't sure where to post. I will test before his shot tonight just to see what happens. I thought if he was 270-328 mid cycle there would be no need. If you feed, test, shoot, how much time between feeding and shooting? Thanks.
 
With Lantus, the test/feed/shoot cycle is best done in about a 15 minute window.

I will test before his shot tonight just to see what happens. I thought if he was 270-328 mid cycle there would be no need.
Click to expand...
Those BG levels can change rapidly from what you got at mid-cycle to the next pre-shot, so it's always safer to test before each pre-shot to make sure the BG levels are high enough to give the insulin.
 
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