Moving post to here for Anatasia

Status
Not open for further replies.
S

scoobydoox

Member Since 2016
Hello, let me introduce my foster cat Daisy and her situation: I take care of few feral cats whom I spayed/TNRed near my house. About 2 months ago someone dumped a very friendly cat on street to fed for herself. When I found her, and took her to foster; I took her immediately to a veterinarian to check for microchip and learned that she is spayed, front declaw, overweight 15 lbs and very sick; young 3-5 years old. Veterinarian started running blood works, urinalyses and urine culture. She had bad case of UTI, and later we learned she is Diabetic as well; her kidneys were very enlarge too.

Last week me and veterinarian started Daisy on Insulin. I home test her with glucometer.
I have some questions regarding Insulin Dosage I read about "tight regulations" by Dr Hodgkins. Dose anyone has links to Dr Hodgkins forum or how can I reach her?
Daisy was put on 2 units twice per day for 3 days (has keytones at 5 trace) and now she is on 3 units twice per day. Her numbers stayingin 300-400. I didn't notice any change in numbers based on increasing insulin dosage. But maybe it was NOT long enough to see deference. She only started insulin last week on Thursday.

I attached her spread sheet

I am in USA/Philadelphia PA. I use Insulin "Lantus/Glargine" @Anastasia
 
FYI. This is Anastasia post. NOT Scoobydoox

scoobydoox said:
Hello, let me introduce my foster cat Daisy and her situation: I take care of few feral cats whom I spayed/TNRed near my house. About 2 months ago someone dumped a very friendly cat on street to fed for herself. When I found her, and took her to foster; I took her immediately to a veterinarian to check for microchip and learned that she is spayed, front declaw, overweight 15 lbs and very sick; young 3-5 years old. Veterinarian started running blood works, urinalyses and urine culture. She had bad case of UTI, and later we learned she is Diabetic as well; her kidneys were very enlarge too.

Last week me and veterinarian started Daisy on Insulin. I home test her with glucometer.
I have some questions regarding Insulin Dosage I read about "tight regulations" by Dr Hodgkins. Dose anyone has links to Dr Hodgkins forum or how can I reach her?
Daisy was put on 2 units twice per day for 3 days (has keytones at 5 trace) and now she is on 3 units twice per day. Her numbers stayingin 300-400. I didn't notice any change in numbers based on increasing insulin dosage. But maybe it was NOT long enough to see deference. She only started insulin last week on Thursday.

I attached her spread sheet

I am in USA/Philadelphia PA. I use Insulin "Lantus/Glargine" @Anastasia
Click to expand...
 
Anatasia:





The Dr H protocol was originally developed for use with PZI and Prozinc. Studies at Veterinary Colleges show that Lantus and Levemir do not work well with the sliding scale approach. Since Lantus is a gentle slow acting "depot" insulin which is slowly released into the system after injection it works best being kept at consistent doses each shot unless increases or decreases are needed.

Here is a lkink to the Lantus forum.
http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

At the top of the listings you will see "stickies" which discuss the TR protocol and other information on testing/shooting Lantus.

This is the direct link to the TR protocol used here.

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/

I do not see a spreadsheet for you. Here is a link to the spreadsheet that everyone on here uses:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
Also what sort of food are you feeding. Wet or dry and brand? Dry food is not recommended at all if attempting to do Tight Regulation. Wet foods needs to be low carb.

What type of meter are you using human or pet?
 
Great catch, ladies!

Another option is to report a post that is in the wrong place and request a moderator move it. When a mod moves a thread for any reason, a notice is sent to the OP and anyone following the thread so they know where to find it in the new location.

Welcome to the FDMB, Anastasia!
 
Tuxedo Mom said:
Also what sort of food are you feeding. Wet or dry and brand? Dry food is not recommended at all if attempting to do Tight Regulation. Wet foods needs to be low carb.

What type of meter are you using human or pet?
Click to expand...


I feed her ONLY wet. Fancy Feast Classic
Meter is Arkray
 
I was using dr h protocol and after much discussion and advice from the forum and specialists I found that the protocol was outdated and depending on what insulin your using it can be dangerous.
Particularly with lantus as it is a depot insulin.
You can see on my ss when I was using the protocol. I was dosing 3/4 times a day on pro zinc.
When that was not working we switched to lantus on the advice of more current information regarding controlling diabetes.
I actually consulted with the dr that took over dr hodgkins practice and she advised lantus.
@Elizabeth and Bertie has experience s well with the protocol.
Please be careful of a hypo episode p

Welcome and bless you for taking this kitty in :bighug::bighug:
 
https://docs.google.com/spreadsheets/d/173mOpK9dfKUzZRSBqYMQF6ZXE7wlcB5_RKwgBnQ1XDM/pubhtml

Hello. Need help and advice on Insulin dosage and regulation protocol. Daisy the cat just started Lantus (Glargine) on Thursday June 1. She is fed wet food only Fancy Feast Classic in last 2 months. Kidneys are enlarge, possible underline kidney deases, cat is young 3-5 years old. BG levels 320-500 (based on human meter). Keytones at 5 trace. Insulin started at 2 units/twice per day for 3 days - dose increased to 3 units/twice per day. Any thoughts? Suggestions?

Spread sheet via link to take a look at
 
Last edited:
Daisy is on 3 units of Lantus now. Her numbers stayed around 350-400 BUT this morning before shot was 532
Any suggestions why her numbers are still so high even with increased insulin dosage? Thank you. Her spread sheet in Signature. Maybe it only was a week since she was put on insulin so not enough time yet for insulin to start working?
 
One thought that comes to mind. Daisy had an increase after only a couple of days from 2 to 3 units. The usual starting dose is 1 unit twice a day and holding for a week until the body climatizes to having external insulin. I am pondering whether the starting dose was too high and/or the increase was too large and too soon. Sometimes too much insulin can look like not enough insulin.

You should do a new post...with the link to this post...in the Lantus forum:

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

If you put a "?" in your new post and something like "Dosing advice needed" you should get more responses. There is a lot more "traffic" there and lots of experienced users. It would be good to get some more feedback on what other think.
 
Welcome to Lantus/Lev Land!! I'm a native of Philly but haven't lived there in a very long time!

One question to direct to your vet that comes to mind is whether Daisy has a UTI or a kidney infection. I'm concerned about the possibility of a kidney infection since you noted that her kidney's are enlarged. Both are treated with antibiotics but it takes a longer course of antibiotics to treat a kidney infection. Any source of infection will cause blood glucose (BG) numbers to be higher than expected. Is Daisy still on antibiotics? Do you have lab values so we know whether Daisy's kidney values are OK or not?

I would strongly advise against your using Dr. Hodgkins' version of tight regulation with Lantus or Levemir. Hodgkins' approach advises against using higher carb foods if numbers drop low. As a result of this aspect of her approach, cats have died from symptomatic hypoglycemic episodes. We use the Tight Regulation Protocol developed by Roomp & Rand which has been published in a leading feline veterinary journal and is based in research. Hodgkins' version is not based on research and has not been published in a scientific journal.

I do think Daisy needs a dose increase. However, if your spreadsheet (SS) is accurate, you shot 2.0u at PMPS on 6/6. Any time you change a dose, you need to give the depot time to stabilize. As a result, I would hold your current dose at least for the AM cycle today and let's see what Daisy's numbers look like by PMPS. If you could post at least an hour before your shot time this evening, we can re-evaluate the dose. You may want to start a thread for yourself prior to PMPS since you won't be able to change the subject line on this thread since your not the original poster (OP).

It would be helpful, though, if you could get a test a little later during the PM cycle. Many cats experience lower numbers at night. There's always a possibility that Daisy's numbers are dropping a little lower at night and bouncing back up by AMPS.



 
Tuxedo Mom said:
One thought that comes to mind. Daisy had an increase after only a couple of days from 2 to 3 units. The usual starting dose is 1 unit twice a day and holding for a week until the body climatizes to having external insulin. I am pondering whether the starting dose was too high and/or the increase was too large and too soon. Sometimes too much insulin can look like not enough insulin.

You should do a new post...with the link to this post...in the Lantus forum:

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

If you put a "?" in your new post and something like "Dosing advice needed" you should get more responses. There is a lot more "traffic" there and lots of experienced users. It would be good to get some more feedback on what other think.
Click to expand...


Ok I will do new post later today after work. I just don't know what to do with dosage at this point? Veterinarian put her on 2 units and 3 days later said 3 units. Of cause I followed instructions. I didn't know about the correct information at that time.
 
Anastasia said:
Ok I will do new post later today after work. I just don't know what to do with dosage at this point? Veterinarian put her on 2 units and 3 days later said 3 units. Of cause I followed instructions. I didn't know about the correct information at that time.
Click to expand...


If it is time to shoot and you are going to be able to monitor you could go ahead with the regular shot for now. It would be good to have some discussions and feedback on the treatment protocol, if you can post in the Lantus forum after.
 
Sienne and Gabby (GA) said:
Welcome to Lantus/Lev Land!! I'm a native of Philly but haven't lived there in a very long time!

One question to direct to your vet that comes to mind is whether Daisy has a UTI or a kidney infection. I'm concerned about the possibility of a kidney infection since you noted that her kidney's are enlarged. Both are treated with antibiotics but it takes a longer course of antibiotics to treat a kidney infection. Any source of infection will cause blood glucose (BG) numbers to be higher than expected. Is Daisy still on antibiotics? Do you have lab values so we know whether Daisy's kidney values are OK or not?

I would strongly advise against your using Dr. Hodgkins' version of tight regulation with Lantus or Levemir. Hodgkins' approach advises against using higher carb foods if numbers drop low. As a result of this aspect of her approach, cats have died from symptomatic hypoglycemic episodes. We use the Tight Regulation Protocol developed by Roomp & Rand which has been published in a leading feline veterinary journal and is based in research. Hodgkins' version is not based on research and has not been published in a scientific journal.

I do think Daisy needs a dose increase. However, if your spreadsheet (SS) is accurate, you shot 2.0u at PMPS on 6/6. Any time you change a dose, you need to give the depot time to stabilize. As a result, I would hold your current dose at least for the AM cycle today and let's see what Daisy's numbers look like by PMPS. If you could post at least an hour before your shot time this evening, we can re-evaluate the dose. You may want to start a thread for yourself prior to PMPS since you won't be able to change the subject line on this thread since your not the original poster (OP).

It would be helpful, though, if you could get a test a little later during the PM cycle. Many cats experience lower numbers at night. There's always a possibility that Daisy's numbers are dropping a little lower at night and bouncing back up by AMPS.


Click to expand...


I am posting her latest CBC blood work. See attached here in min
 
Anastasia said:
I am posting her latest CBC blood work. See attached here in min
Click to expand...


Regarding UTI: she had urine culture done- NO Infection.
REgarding Kidneys: few veterinarians are still debating if she has kidney disease OR diabetes OR both (diabetes with underline kidney disease)

She is NOT on antibiotics or any other meds. Just insulin.
She took Clavamox over 2 months ago for UTI but even back than vet was refusing to give antibiotics saying they id not see any infection in urinalysis
 
There's a tab on your spreadsheet where you can manually enter lab test data. It allows you to keep everything in one place and see any changes in lab values over time.
 
Anastasia said:
Labs attached
Click to expand...


Looking at the lab results and considering that there are no glaring problems showing and the blood glucose was only slightly above normal reference ranges, I am wondering why the dose was started at 2 units.

Not sure if anyone else has something to add to this.
 
Tuxedo Mom said:
Looking at the lab results and considering that there are no glaring problems showing and the blood glucose was only slightly above normal reference ranges, I am wondering why the dose was started at 2 units.

Not sure if anyone else has something to add to this.
Click to expand...


I don't know. maybe cat needs antibiotic and does not need insulin??? I don't know and vet said this cat is not your typical case.
 
Last edited:
Anastasia said:
I don't know. maybe cat needs antibiotic and does not need insulin??? I don't know and vet said this cat is not your typical case.
Click to expand...


If there is no infection and Daisy does not have any dental issues then antibiotics are not indicated. I don't know what your vet meant about her not being a typical case. Is it because of her age?
 
Tuxedo Mom said:
If there is no infection and Daisy does not have any dental issues then antibiotics are not indicated. I don't know what your vet meant about her not being a typical case. Is it because of her age?
Click to expand...


Veterinarian: said she is NOT straight forward diabetec cat, said her case is complex, between possible kidney disease and diabetes. Vet is not 100% sure what she has
 
One veterinarian: said: Diabetes needs insulin
Second veterinarian said: Kidney disease needs special kidney diet
Third said: Diabetes with underline kidney disease go see Internal Specialist
 
Anastasia said:
Veterinarian: said she is NOT straight forward diabetec cat, said her case is complex, between possible kidney disease and diabetes. Vet is not 100% sure what she has
Click to expand...


Unless I am missing something the lab results do not show any serious kidney disease.

It is unusual for a younger kitty to have diabetes, but it can happen. I am still questioning the dose she was started with and the large increase so quickly after starting.


ETA I am tagging some members who are experienced at reading lab results and see if they can see anything there that indicates a problem when they come on @Marje and Gracie @Wendy&Neko

Link to lab results:
http://www.felinediabetes.com/FDMB/attachments/daisy_labreport-pdf.21130/
 
Tuxedo Mom said:
Unless I am missing something the lab results do not show any serious kidney disease.

It is unusual for a younger kitty to have diabetes, but it can happen. I am still questioning the dose she was started with and the large increase so quickly after starting.


ETA I am tagging some members who are experienced at reading lab results and see if they can see anything there that indicates a problem when they come on @Marje and Gracie @Wendy&Neko

Link to lab results:
http://www.felinediabetes.com/FDMB/attachments/daisy_labreport-pdf.21130/
Click to expand...



I guess dose was done based on high blood glucose on glucometer. Vet used glucometer at office that day to check for BG.

Yes cat is young only 3-5 years the most. Teeth looked good acordig to vet
 
OK There are 2 sets of lab results

One is from March 11 and the other is from May 27.

The BUN, Creatinine and SDMA have gone up slightly between March and May but are all within normal ranges. Those are what would usually indicate kidney issues.

The glucose was 203 in March and 354 in May which is a definite increase. However it depends on when each test was done. If they were both done as fasting tests then that indicates a rising problem with FD. However if the March one was done as fasting and if Daisy had eaten not long before the May test, then the numbers would not be comparable.

In any case there have been kitties here who have had numbers in the upper 400s when diagnosed and the starting dose was 1 unit, held for 7-10 days then increased at 1/4 unit increases as needed. My view is that it was a larger starting dose and then a fast and large increase after only 2 1/2 days. I would still like to get more feedback on this from the Lantus forum;

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

If you could post there and copy of link to this posting you should be able to get more input.
 
Tuxedo Mom said:
OK There are 2 sets of lab results

One is from March 11 and the other is from May 27.

The BUN, Creatinine and SDMA have gone up slightly between March and May but are all within normal ranges. Those are what would usually indicate kidney issues.

The glucose was 203 in March and 354 in May which is a definite increase. However it depends on when each test was done. If they were both done as fasting tests then that indicates a rising problem with FD. However if the March one was done as fasting and if Daisy had eaten not long before the May test, then the numbers would not be comparable.

In any case there have been kitties here who have had numbers in the upper 400s when diagnosed and the starting dose was 1 unit, held for 7-10 days then increased at 1/4 unit increases as needed. My view is that it was a larger starting dose and then a fast and large increase after only 2 1/2 days. I would still like to get more feedback on this from the Lantus forum;

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/

If you could post there and copy of link to this posting you should be able to get more input.
Click to expand...


How do I post in that forum you suggested? I wonder if I should start her insulin dosage from scratch like start slow and go: 0.05 BUT not sure if thats safe? Since she is on 3 units already
 
Anastasia said:
How do I post in that forum you suggested? I wonder if I should start her insulin dosage from scratch like start slow and go: 0.05 BUT not sure if thats safe? Since she is on 3 units already
Click to expand...
Click on the link and start a new thread top right button to post in that forum. Less insulin is always better than giving to much insulin which can kill. starting lower would be safe.
 
scoobydoox said:
Click on the link and start a new thread top right button to post in that forum. Less insulin is always better than giving to much insulin which can kill. starting lower would be safe.
Click to expand...
ok what should I do now? reduce her dose? Or just start with 0.5?
 
This link:

http://www.felinediabetes.com/FDMB/forums/lantus-glargine-levemir-detemir.9/create-thread

will take you directly to the "start new thread" entry on the Lantus forum.

You would put a title in something like "Dosing advice needed" with a "?" using the drop down box on the left of the Title panel. Then go to the body of the message and post this link:


http://www.felinediabetes.com/FDMB/threads/moving-post-to-here-for-anatasia.159062/#post-1696935

That will post a link to this thread so that people can read what has been talked about already.

Then put a basic message like....Just starting Lantus. Not sure if the dose is correct. Can anyone advise. Then people will post their opinions and advice and you can see what the general consensus is.

I would get a few more opinions before dropping back to 1 unit, although that would seem like a good starting point and then slowly work the dose up as needed.
 
Advice to Suggestion Givers: Know the principles; know the exceptions. "Every cat is different" is not just a slogan. There are general guidelines that work for most cats, and then there are the cats that didn't read the manual. You need to know about both in order to help with the complicated cases.
Tuxedo Mom said:
I would still like to get more feedback on this from the Lantus forum;
Click to expand...
Fedback has already been given in the Lantus/Levemir forum:
Lantus Insulin/ Need help regulating /choosing correct dosage for a cat who just started insulin

If Daisy hadn't been throwing ketones, lowering the dose might be the way to go. However, a kitty who has been throwing ketones within the past week make this a complicated situation... an "exception" to the rule. @Marje and Gracie and I recognized that the other day and gave the reasoning behind our suggestion to increase the dose to 3.25 units bid in the link above (posts #10 thru 19).

Over and over again we see recommendations to lower the dose when it *appears* to be too high in ketone prone kitties (having recently thrown ketones). It rarely, if ever, works. All that usually happens is the advice to significantly lower the dose ends up setting the caregiver back weeks, if not months, AND kitty almost always begins to throw ketones once again.

Anastasia said:
ok what should I do now? reduce her dose? Or just start with 0.5?
Click to expand...
Anastasia: Since you've already given 3 consecutive cycles at 3u bid, you could continue that same 3u dose for a total of 6 consecutive cycles (unless the numbers tell you otherwise), but I would test for ketones at least once a day AND I would try to get another BG test or two in the PM cycle as Marje mentioned the other day.

If Daisy begins to throw ketones again, I would immediately take the dose up to 3.25u bid and post for help. Like I mentioned the other day, if I were you I would have already increased the dose to 3.25 units bid when you originally asked.

The advice given is what I would do if Daisy were my cat, but all decisions are yours to make. Daisy is yours and you hold the syringe. Gather opinions and do what makes the most sense to you.

Going forward, you'll find those with the most Lantus/Levemir experience in this group:
Lantus (Glargine) / Levemir (Detemir). Many will post there everyday until they get the hang of things.
 
Thank you for clarifying Jill. At the time I posted Anatasia had not posted in the Lantus forum. I had advised her earlier to post there for opinions before making any changes to her doses.
 
Status
Not open for further replies.
Back
Top