My first curve

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MiloMistyMax

Member Since 2012
I am not a tight regulation person but it seem like most of the Lantus people are here so I will try posting here :smile:

I decided to test Milo every 2 hours since I just switched his dry food from the DM to Evo and made sure he didn't eat very much of it. Also his preshot on the ReliOn was 120 so I was a little bit worried but I didn't want to screw up again with a 100 number. Every time I have seen that low I either skipped or gave 1 unit and although I didn't test the nadir, the next preshot was always over 400 or 500. Sooo I gave him 2 units which is what I have been sticking with since PM 12/22. My vet started him on 3 units but he said to go down to 2 my last visit. Which I now know is too much of a reduction.

PMPS 120 - 2 units - fed canned DM reg + gravy
+2 176 - I got scared here and gave him a little more food when I normally wouldn't
+4 205
+6 238 - fed canned DM reg + gravy
+8 297

And I will test in an hour and then the preshot after that. Is the number going up because of the food I gave him? Or is it because the dose isn't right?

I did my first ketone test a few hours ago and it didn't seem to change color at all, but when I brought it upstairs to throw it away it almost looked like the trace color in the different light but I am not sure. Is that bad? I will test again next time he goes. He isn't acting different or anything but I worry.
 
Welcome to the "other" side of Lantus! Good job on getting the curve.

FWIW, not everyone here uses the Tight Regulation protocol. There are several people who post regularly who use the Start Low Go Slow (SLGS) approach. This is a busy board and there's often someone around 24/7 if you need help.

Just so you're aware, you have more than the option of skipping a shot if you have a low pre-shot number. This post on handling low pre-shots (which is also in the Shooting & Handling Low Numbers sticky) will go over those options.

The switch to EVO is a good one if Milo is a hard food addict. If no one has mentioned it previously, Dr. Lisa's website on feline nutrition has an excellent section on how to transition a cat over to canned food. Because you're switching from a 14% carb to a dry food that's 8% carb, it would be wise to keep an eye on Milo's numbers. That drop in carbs may have a good effect on his numbers but you don't want to be caught unaware if he starts throwing you some unexpectedly low numbers.

There's a reasonable chance that Milo's numbers were lower than the 120 you saw at PMPS. What I think you've been seeing with the curve is a bounce. In fact, there's a good chance that Milo's been bouncing which is what the high pre-shot values reflect. There's no way to know, however, without some spot checks during the cycle. Since most of our cats have been in high numbers prior to diagnosis, their bodies are no longer accustomed to being in normal BG numbers. When they get closer to normal range, their body overreacts. When this happens, a stored form of glucose along with counterregulatory hormones are released. This causes numbers to spike upward or "bounce." It can take up to 72 hours for a bounce to clear.
 
Hi Angela, welcome to LantusLand! We think it's the best place you never wanted to be. :lol: :lol: But this is the best place to get advice and support for treating feline diabetes. Milo is a very handsome guy! You are doing a great job with the testing, that is hard to do at first but very important. We strongly recommend a pre-shot test (which you are doing every time, good job!) and a mid-cycle test (+5, +6 or +7 is ideal, but even a +3 or +4 right before bed or going to work is fine). Dosing is based on the nadir with Lantus so you need to have some idea of how low Milo goes in the middle of the cycle.

It looks to me like Milo is bouncing from the 120 (or lower in the night). The liver reacts to the lower numbers and dumps some chemicals (Sienne can explain that better than I can) and the BG goes sky high. Ugh. It's the bane of LL but all you can do is wait it out, up to 72 hours. Be sure to keep the same dose, every 12 hours, unless he is low, like below 150. Then we can help you with what to do.

We also recommend totally wet food since the dry food has way too many carbs and it's dry (diabetics are constantly dehydrated). Some cats are dry food addicts and it's tough to get them on wet food and others are delighted with wet food.

That's great that you are testing for ketones. I think you need to do the reading at a set time after the strip is dipped in urine so maybe if you waited longer than that, it wasn't an accurate reading. Definitely test again. It sounds like Milo is very accommodating. :-D

We are all pretty much cat crazy around here and will do everything we can to help you care for Milo. Please ask any questions that you have. It's a lot of information to take in.

Liz, Zener's other mom (I sign my posts and Anne doesn't)
 
Welcome to Lantus Land, Angela and Milo. We're all glad you found your way here.

That was a nice (I know but scary for you, now) PMPS Milo had last night. I hope you get to start to see more blue numbers and get used to them, soon.

If you add Using SLGS to your signature, it will help us remember that you're not using the TR approach.

I hope you have a great day, today :-D
We are here to help you when you have questions.
 
It makes me feel a lot better knowing I have some help. I have learned a lot already from this forum. I am feeling pretty optimistic at the moment but that could change at any time.

I have been checking out Lisa's food list and wrote down a bunch of canned food to try. I think if I could get him to eat an entire can of Wellness chicken or turkey in a day, that would be perfect. I will wait to do that though since I just changed the dry. It's also good to know for my other cats. I have never understood the labels and have always free fed. My other cats get the Fancy Feast grilled sometimes, I didn't know the carbs were so high. I bought them because one of my cats, Max, often won't eat because of his anemia so I have tried so many kinds to find something he will eat. He really likes Milo's DM dry food so I will let him finish it off.

I feel like I am getting the testing down. The last 5 tests I got in just one poke. It's weird how excited that makes me. And I have been using the ReliOn which makes me feel so much better. I like the AlphaTrak but the strip prices are just outrageous.

I am interested in the tight regulation but I am not ready for that just yet. Is that something to start right away or should I get more data first? I am thinking his food changes should be done before.

Thanks for all your help ;-)
 
Getting testing down is probably the biggest hurdle so congrats for getting the process under your belt. As for Tight Regulation, it's not as hard as you may think. There are a few basics:
  • Feeding low carb is very important. The switch to EVO is good but an all canned diet is better. One trick with transitioning is to pulverize some of the EVO and sprinkle it on Milo's food rather than feeding him just dry.
  • You want to try to get at least 4 tests per day -- your two pre-shot tests and one additional test during both the AM and PM cycles. More tests are better but getting tests at random times is also a good start.
  • You will have a set of guidelines for when to increase and decrease doses. Sometimes, this seems complicated but it's really not. It's a road map.

The details of the modified version of the TR protocol are in the sticky note. There are also links to more formal versions of the protocol To my way of thinking, having a set of guidelines makes this process a lot easier and far more reassuring than flying by the seat of your pants with respect to dose.

What I would suggest is that you follow the exchanges in several of the threads (we call them "condos") here. This will give you a better feel for how the TR protocol is used in real time.
 
I don't have any advice. I just wanted to say welcome to Lantus Land. You did a good job getting that first curve done. Keep up the good work.

I use the SLGS Protocol and have that in my signature like Dyana mentioned.
 
Dosing is easy - just ask Sienne what to do. :lol: :lol: Marje is also an excellent dosing advisor. You are doing a great job keeping your spreadsheet up to date - that is the main tool for seeing what's going on with a cat.
Liz
 
Welcome to Lantus Land, Angela and Milo!

You've gotten good info today and we're glad you are here. I do want to add that one of the prerequisites to following TR is feeding low carb canned or raw food.

From the Sticky on Tight Regulation Protocol:REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:

Kitty should be monitored closely the first three days when starting Lantus or Levemir.
Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
More monitoring may be needed.
It will be necessary to test kitty's blood glucose levels multiple times per day.
Learn the signs of and how to treat HYPOGLYCEMIA and prepare a HYPO TOOLBOX.
Test regularly for ketones and know about DIABETIC KETOACIDOSIS (DKA).
Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
Feed a high quality low carb canned or raw food diet.
Feed small meals throughout the day. Some kitties adapt well to free feeding.
Click to expand...

The bold above is mine. The reason this is important is so you have more tools to manage any low numbers. It takes a while for dry food to raise the numbers. Let's say you get a 55 on a +6 test, for example....we would normally have you try some LC canned food to see if you could get him to just "surf" there. If you give him dry food, it will take a while and he could drop more.

But we welcome all lantus users here regardless of what protocol they are using and we are versed in both TR and Start Low Go Slow Protocol and will be more than happy to help you in any way we can!
 
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