More info. on Tight Regulation

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Daphne#5 GA

Daphne#5 GA

Member Since 2011
Hi All,
I read all the info on this board and I'm pretty confused. I've been testing (newly diagnosed in Nov.), since Nov. 2011 and I have her spread sheet here. I guess I just don't understand the basic goal to achieve remission. Do I give larger amounts of insulin to keep her numbers below 40 or 50, and then try to keep it at that number at all times? Or, are we trying to minims the times we give insulin/and or amount of insulin. So I guess my main question is, what exactly makes are kitties go into remission? I think she has pretty stable numbers now, nothing too scary, but it looks like from what I read, that she should be below what she is. I do see I must now test +1-+2 and +10-+11 and keep testing every 20-30min. but I don't know how to understand the data I will retrieve. I guess if I post the spread sheet with all the info, maybe someone will help me on what to do with the numbers. I have an illness and I'm not totally sure I can give the times that it may seem to require, but I wanted to try it at least.
thanks for anyones help
Barb and Daphne
 
Hi Barb. We will help you to help your Daphne. First, I would encourage you to post as often as you can, and to keep asking questions.
What we want to do is to keep the numbers in a non-diabetic range (50 to 120) as much as possible, and to be patient, and go slowly, don't rush it. Right now, her numbers look good, but I would very strongly encourage you to test before every shot, so that you know whether it is safe to give her her insulin, or not. And, then when you can, try to get mid-cycle numbers (the lowest numbers of the cycle), so that you can tell how the insulin dose is doing.

Others will be along to help you more.

Keep asking questions, as they come up. We are here to guide you and help your kitty.
 
Welcome to Lantus Land.

Like Dyana said, tight regulation is a dosing protocol the goal of which is to get a cat into a normal BG range as quickly as possible. That doesn't mean that you want your cat sitting in numbers that are below 50. With regard to lower numbers, there are two ways that a cat's insulin dose can be reduced. The first is for numbers to drop below 50. The other way for a dose to be reduced is for numbers to stay below 120 (preferably below 100) for a week at a time. Based on the protocol, either of these criteria allow you to slowly reduce your cat's dose.
Barb & Daphne said:
Do I give larger amounts of insulin to keep her numbers below 40 or 50, and then try to keep it at that number at all times? Or, are we trying to minims the times we give insulin/and or amount of insulin.
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You don't want to be administering more insulin than your cat needs nor do you want to minimize the amount or frequency of shots. Rather, you want to maintain a steady, consistent amount of insulin to help support Daphne's pancreas while it's healing. (Think of insulin like putting a brace on a sprained ankle -- you're giving the injured ankle support while it heals.)
So I guess my main question is, what exactly makes are kitties go into remission?
Click to expand...
A cat is in remission, or perhaps more correctly stated is diet controlled, if insulin is tapered down to nothing and, after a 2-week trial of no insulin, that cat remains in a normal BG range. A cat goes into remission when and if her pancreas heals and the insulin producing cells in the pancreas kick back into gear.

With Lantus and the TR protocol, there are several important features.
  • You want to be giving the same amount of insulin twice a day, 12 hours apart. (There are exceptions -- notably if you have too low of a pre-shot number to give insulin.)
  • You base your dosing on the nadir, not the pre-shot numbers. As a result, you need to get spot checks during the AM and PM cycles.
  • It's imperative to test before each shot to insure that it is safe to give insulin.

Daphne's numbers are looking very, very good. If you can get a consistent test at your pre-shot times and at least one test during the AM and PM cycles, this may tell us whether it's time to adjust Daphne's dose.

I notice that you're feeding M/D. (I'm amazed that Daphne will eat it!) There are other, non-prescription foods that are less expensive and are higher quality. M/D is primarily made up of animal by-products vs. muscle meat. It is also 14% carb. You could be feeding a premium, human grade cat food that is less than half of the carbs (e.g., Wellness chicken or turkey is 4% carb). I suspect that if you reduce Daphne's carbs, you are going to see even better numbers.

Please let us know how we can help. I hope I haven't added to your confusion. If you have questions, please ask. People here are very generous with their time and their knowledge.
 
It seems to me, and I'm only here since November, too, but it looks like you really need to do a curve on a day when you can. That means test at preshot and then every two hours until the next preshot. You really need to see where the low point of the cycle is going in order to help you dose correctly. Your preshot numbers are actually very good, but with the amount of insulin Daphne is on, I'd be really concerned about how low she is going during the cycle itself. Those are the numbers you will base your decisions to increase or decrease the dose on, not the preshot numbers so much. With her preshot so low to start with, you really should get those numbers tonight at +2, +4 and +6 at least, to make sure she's staying above 50. Below 50, you want to think about treating for hypo and that's when you need to test every 20-30 minutes, to make sure she is climbing back to a safe range.

I'm sure you can get more advice from the more experienced members, as Mikey is still in the early stages of regulation, and the TR protocol may never work for him, but I would be most concerned right now about getting those mid-cycle numbers to make sure Daphne stays safe.

Those preshot blues look great, so start with how low she goes in between and go from there!
 
Hi Barb and Daphne and welcome to Lantus Land.

I assume that you have read the "Stickies" (informational posts at the top of the Lantus forum). If not, be sure to start with the "New to the Group". It contains most of the information about Lantus (how to determine the dose; when to raise the dose; how long to hold a dose), curves, etc. that is confusing to you at present. Daphne looks like she is doing pretty well on the 2 units, but without spot checks in the middle of the cycle, it is hard for the people here who are especially knowledgeable about Lantus dosing to give you advice or help. I suggest that you change your subject line to something like: "newbie needs help with Lantus dosing". Your present subject line suggests that you are offering "more info. on Tight Regulation", rather than asking for help. Go back to your first post today and edit the subject line there (otherwise it will not show in the list and you won't get any experienced eyes on your questions).

In general, I would focus on trying to get tests at about +6 (the nadir--the lowest number of the cycle-- usually falls around mid cycle and Lantus dosing is based on the nadir, not on the pre shots). Always get a bedtime test. At some point when your schedule permits you can do a curve (AMPS +2 +4 +6 +8 +10 PMPS) or a mini curve (AMPS +3 +6 +9 PMPS).

Again, welcome. We are glad you are here and we are all here to give support and help.

Ella & Rusty

p.s. I see that while I was writing this many of your questions have already been answered. You've gotten good feedback already!
 
hi barb! i remember when you and daphne came on a while ago. welcome back.

what a lot of people find the easiest is to post daily and people with more experience will teach you and let you know what to do at each step. as you said, it's hard and sometimes confusing. so i'd encourage you to post as much as you can.

for tonight, i hope you check back in. that's the lowest number you've ever shot, and daphne is likely to get lower mid-cycle. when, i don't know. i'd get a test when you check back in, whenever that is, and post here. if you edit the first post here you can change your subject line and put in the next BG test #.

we would normally expect Daphne's blood sugar to continue to drop until about 6 hours after her shot, then to come back up. however, every cat is different, and some cats get lowest earlier or later in the cycle. i really want to encourage you to test tonight.

if you see a number less than 50 here is a post with instructions. Don't Panic, or How to Handle Low Numbers
 
I just want to add a point or two. You mentioned you may have some limitations with regard to testing. Getting a curve isn't essential. Nor is it desirable to always test at +6. If you are limited as to when you can test, getting tests at different points in the cycle will help to fill out all of the different time slots on your SS. You want to be assured that you're not missing any possible dose reductions given how well Daphne is doing.
 
Re: Need help with Lantus dosing

Ok, what happened a few minutes ago, I tried to post a reply and the page would not send. So below, I will paste it in (I saved it, so I hope I can copy/paste on this). And since I need to do that I will change the subject also, as advised. Thanks also for the two post I just read, after I wrote the first reply. I'm going to re-read all of them again tomorrow…lots of info, but I think I can manage this. Oh and don't worry, I did test after that low one, @ +6 and its 150. I may be seeing those numbers because I give her a 1/4 can DM for a snack each night at 11:30 (+6). I'm not sure what I'm supposed to do about the snack thing. I'm going out to buy the new food tomorrow. So below is what I first wrote. Thank you all! Some great advice, and most of my questions were answered. So I will try to keep her numbers in the non diabetic range 50-120 as much as possible (still a bit confused about my part in keeping her in that range). And I know mid cycle is supposed to be the lowest #'s, but they aren't all the time…thanks Dyana. "Maintain a steady consistent amount of insulin to help support Daphne's pancreas while it is healing". Thanks Sienne & Gabby, thats the answer I was wondering about…it makes sense to me. Oh, and food, yes, I have had 4 other cats and always feed the best foods, no animal by-products, but when the Vet diagnosed one of my other cats, he said that was the food to give her, so now that Daphne is diagnosed, the vet gave me the same food. I did read the very informative paper that a Vet wrote someplace on this board. I was just wondering what kind. This Wellness brand sounds like a good one, I assume just the Chicken and Turkey would be the 4% carb. Oh and someone, I think Mikey's Mom, I did do two curves, but maybe I never put it on the spread sheet. And Ella and Rusty, also, good advice for new subject, "Need help on Lantus dosing". I see you have a Main Coon, my Carly was a Main Coon, she was very special to me, one I can't ever forget, still painful 7 years later.
Thanks all, and I will try to post this with the new subject suggested!
Barb and Daphne
 
you did fine, barb! i'm so glad you caught a +6 test and she's fine.

there was an announcement posted a few days ago that the site was going to be down for about 15 minutes sometime tonight or tomorrow, so that might have been what happened when you tried to post. a couple of others said they got kicked off. i don't think it lasted 15 minutes, though. in any case, likely that's what happened.
 
Hi Barb:

Welcome to you and Daphne. You've asked alot of good questions. The reason your post did not submit at first was because the site went down for scheduled maintenance for about 15 minutes.

Very few people here feed the Purina DM. Yes...the Wellness is an excellent food; the turkey, chicken, and beef/chicken are all 4%. Many of us feed Wellness.

We have quite a few "stickys" at the top of our Lantus page that have a lot of good info. If you get a low pre-shot, then don't feed, and post for help. We can walk you through it. There are links to shooting low numbers and low preshots in my signature block.

We're glad you and Daphne are here!
 
Barb

You will need to be especially careful of Daphne going into dangerously low numbers when you change her food over. The food you will be getting for her is much lowever in carbs than the DM so it may be that her BG will drop somewhat because of the change in food and she may require less insulin because of this alone.

Serryn

I note that I am at work at the moment and can't access Daphne's spreadsheet from here so I haven't seen her numbers.
 
Thanks for adding that Serryn. Yes, going from 14% carbs to 4% carbs or lower, will have an effect on the blood sugars.
I would test more at least in the beginning of the food change, to make sure to keep her in a safe range.
If you don't already have it in stock, please pick up some cans of high carb food (18% carbs) as well to keep on hand, just in case you should ever need to raise the bg in a hurry.
 
Adding my two cents :smile: Don't get caught up in the numbers and focus only on getting numbers under 100 and achieving remission. You need to focus on the whole cat. The main thing is to have an otherwise healthy and happy cat with all 5 Ps. Numbers will go down if you are patient and follow the Lantus protocol :smile: If you don't ever reach remission, and some cats do not, don't feel like you let your cat down. My Merlin (GA) was diabetic for 4 years and his bgs never really got down to normal levels. He preferred to stay up in the 200s and 300s with mid cycle numbers sometimes in the 100s or lower despite trying 3 different insulin (N, Lantus, and Levemir) and various dose changes (as much as 4 units BID). We had once nice stretch of 100s and lower for a few months until they went back up for reasons unknown. And we did do the low carb canned diet. Merlin was happy, though :smile: As for healthy... well he was kind of defective (had some non-FD issues) :razz: But I wouldn't have given him up for anything in the world cat_pet_icon
 
Thanks to all, your help is so greatly appreciated. I got a little frustrated today and posted a frantic request for diet help. I went to the special pet shop and thought I got a really great food for Daphne, but came home and it had carrots in it, and eggs. So I read the very complicated diet/food information page and just got even more confused. So I did try and call the company, but its Friday night now and probably won't get anyone till Monday. Her numbers went up today anyway, so I wouldn't have changed her food today, not till I can get her back to her normal numbers. I guess when her BG went low the day before, I gave her .25 less and now it made it go up a lot, so now I'll just give her the regular amount and then try the new food. I didn't read these posts till I got home and did the research on my own, so now I can go back and look for that Wellness brand. The one I got was EVO, Turkey/Chicken, but I don't like seeing the carrots in it. I probably will have a response for the post I just made for "diet help".

Thanks again everyone!
Barb and Daphne
 
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