NEED HELP/OPINIONS for LULU

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amber7

Member Since 2014
Good afternoon all!
I have a 7 year old female domestic longhair named Lulu. She was diagnosed back in May 2013. About 9 pounds. Vet says she is at a healthy weight-just a petite little girl.
She has been on Lantus since the diagnosis. We started out at 1 unit 2x a day but it has fluctuated to as high as 3.5 based on the vet's recommendations.
She's currently at 2 units. Eating FF Classics chicken only. Using the AlphaTrak 2 meter.

Below I have posted some curves that I have done. I spot check as well as do 12 hour curves on the weekend.

I'm frustrated because I don't know why we can't get her to stabilize. So many factors! The meter, me, her, the vet...something is not working right.

I apologize that I'm not up to date on the lingo :) And I will get all of my data onto a spreadsheet. Below is a sample of the past month or so.

*I don't have exact numbers from yesterday's curve (left them at home-can post later) but she was running in the 300's for the majority of the day. I'm trying to measure out 2.25 best I can.


3/22/14 (2 units)
5:55AM 568
6am fed and inject
8am 404
10am 427
11:30am 373
2pm 402
4pm 380
6pm 379

3/16/14 (2.5 units)
5:55AM 317
6 AM fed and inject
10AM 45
12PM 63
2PM 162
5:55PM 370
6PM fed and inject

3/1/14 (3 units)
5:55AM 480
6AM fed and inject
9AM 285
12P 55
3PM 91
5:55PM 484
6PM fed and inject

2/17/14 (3 units)
5:30AM 364
6AM fed and inject
8AM 385
10AM 261
12PM 199
2PM 181
4PM 175
5:30PM 230
6PM fed and inject


1/12/14 (3.5 units)
6am post food/injection 377-we fed and injected right after
10am 399
12pm 290
2pm 398
6pm right before food/injection 382

As you can see, we are all over the place. I'm debating whether or not to find a different vet. Or, try some different foods. Thanks for your input. If I left out any info, let me know. Thanks again!
 
Hopefully someone with Lantus experience will chime in, but seeing how LULU has been on Lantus for a while with no results maybe another type of insulin is in order? When Hidey was first diagnosed my vet put him on vetsulin (although I was told prozinc but thats a whole different story lol) and his numbers werent changing. I DEMANDED prozinc and after much trouble got him put on it, now his numbers are pretty stable. Have you tested ketones? Has the vet checked to make sure theres no other issues? As of food, the classic chicken is 4% carbs maybe she needs something lower in carbs than that, although I wouldnt see that percentage making THAT big of a difference, but I'm still a newbie. Is there any dry food being given?

I know my main issue was the dry food, but since I switched to a better food Hideys numbers drastically changed.
 
I keep the ketone strips in her litter box. I haven't seen any sign of them yet.

No dry food at all. Before she was diagnosed, she was on dry and a grazer.

Upon diagnosis, we went on Hills MD wet. I found the chart with carb %'s so we switched to FF since it was lower in carbs. We didn't really see a difference in the food change.

She gets 1/2 a can of food (can is 3 oz total) in the morning and at night with the injections. I freeze the wet food and put down 1 whole can while i'm at work and 1 down while we are sleeping. I'm also open to suggestions. Is she getting enough, too little, etc?


Thanks!!

I'm open to trying new insulin.
 
Nikki's Mom said:
Just wanted to bump this up. I noticed that you had a 45 reading at one point? On an Alphatrak that is VERY low.
Click to expand...

I agree! I freaked out that day and called the vet. We gave her karo syrup and watched her closely but she didn't show any signs. Right after that curve, the vet told us to go on 2 units. And we have been but as you can see from 3/22/14 curve that 2 units wasn't enough and she ran high that day. So frustrating!
 
Maybe shes getting too much food??? From what I gather from your post your feeding her 3- 3oz cans of ff chicken thats 273 calories, if you go off the general formula that someone posted for me when I was adjusting Hidey's feeding, [13.6 X optimal lean body weight in pounds] + 70, that would be 192.4 calories a day. Maybe try a higher protein lower carb food, that way you can feed her less but she has more protein so she wouldn't be hungry and missing the extra food. IMO though I would look into a different insulin as well though. If her numbers are bouncing around like that then maybe lantus isnt for her. That was how Hidey was on vetsulin, I read about other insulins and switched him and now he's pretty level. When was the last time they did blood work on her to rule out other issues?
 
We'll be able to help you more once you've got your data into a spreadsheet. But from looking at the data you have got, it looks like her dose has been too high. As Nikki says, some of those readings on an AlphaTrak are very low. With the Tight Regulation protocol that many of us use, any number below an 80 on an AlphaTrak means a reduction of .25U. That 45 you got on 3/16 would mean a new dose of 2.25U. Most of us here do not go to the vet for dose changes. We follow the protocol and get opinions from experienced members on when and how much to change the dose. I started out getting recommendations from the vet, but stopped after a few weeks as the people here have a lot more experience with Lantus that does my vet. As long as you are testing before each shot, getting spot checks during each day and getting more data on the weekend, you should be able to get help here.

The other thing that you may be seeing is what we call bounces. Take a look at the second post here for a definition of bounces. Depending on when you did your curve, it could have been a day of high numbers which you'd think might mean increase the dose, but it doesn't.

As long as Lulu is maintaining her weight and eating low carb food, the amount of food should be OK if the vet thinks she's at a healthy weight.

If you are worried about the meter, most of us here use human ones. The strips are much cheaper, are more readily available, and the protocol supports the use of either meter. But some still use the Alphatrak, the choice is yours.
 
Thank you for all of the input. Is there a template anywhere that I can use for her readings? Or do you guys just use Excel?

So you guys are recommending to stay with 2.25 units for now? I will keep spot checking throughout the week and do a 12 hour curve on Sunday to see how the 2.25 is doing. Pretty tough to measure!

This is a good point! "The other thing that you may be seeing is what we call bounces. Take a look at the second post here for a definition of bounces. Depending on when you did your curve, it could have been a day of high numbers which you'd think might mean increase the dose, but it doesn't."
 
Oh yes, we have a standard template to use and it certainly makes it easier if everyone uses the same format.

Directions on how to set up our standard color coded template are here. The one step that is missing from the directions, is to change the share options for the document to "anyone with the link". That will give us read only access and let us see what is going on with Lulu.

Explanation of the template:

BJM said:
Understanding the spreadsheet/grid:

Each day is 1 row. Each column stores different data for the day.

From left to right, you enter
the Date in the first column
the AMPS (morning pre-shot test) in the 2nd column
the Units given (turquoise column)

Then, there are 11 columns labeled +1 through +11
If you test at +5 (5 hours after the shot), you enter the test number in the +5 column
If you test at +7 (7 hours after the shot), you enter the test number in the +7 column
and so on.

Halfway across the page is the column for PMPS (evening pre-shot)
To the right is another turquoise column for Units given at the evening shot.

There is second set of columns labeled +1 through +11
If you snag a before bed test at +3, you enter the test number in the +3 column.

We separate day and night numbers like that because many cats go lower at night.

It is merely a grid for storing the info; no math required.
Click to expand...

ETA: Oops! Looks like a little cross posting with Wendy!
 
Here's a post on how to create a spreadsheet in the format we all use.

What dose is Lulu on now? It's been a while since that last curve, things could have changed. I think most of us have magnifiers and good lights to measure those quarter doses. Some people even use calipers to measure the dose. If you read this introduction post, there are some pictures of .25U doses.
 
Good job on getting the SS set up and linked into your signature. That sure dose help us to see what is going on so thank you so much for getting that set up and some data entered in the SS.

I see from your SS that you are only testing about once a week, running curves. It's a good idea to test before every insulin shot so you know Lulu isn't too low to shoot. Next, some tests around the middle of the cycle are good to see, to pinpoint the nadir. Lantus dosing adjustments are made based on those nadirs.

Lulu definitely earned a reduction from 2.5 to 2.25, as she dropped to 45. It's really hard to tell what went on in between the 17th and the 23rd of March since you don't have any test data.

Since you are only testing once a week, you may be catching Lulu on one of her bounce days, when she had dropped much lower and her body compensated to keep her safe and having a hypo.

Hope to see some more test results, especially those daily pre-shot tests that help you to keep Lulu safe.
 
Hi there and welcome to the board.

As you have realized, the previous dose was too high. Every time they drop below 80 on an alphatrak it means a reduction of 0.25units. So now you should be on 2.25 units. The protocol now says hold the new dose for 3-5 days to let it settle before making another change.. Unless she drops under 80 again which means another dose decrease.

This drop under 80 may well happen in a day or two once her bounce clears so it's important to get tests more than once a week. Because going under 80 is dangerous and you don't want a hypo, but also because you want to know what's going on and how the new dose is working!

I usually recommend 3-4 tests a day

- always before the shot - this is mandatory as you don't want to shoot when too low. As a newbie this too low number is 200 but is reduced over time once you have the data to know if its safe.
- mid cycle - 5-7 hours after morning shot depending on your schedule. This is to see how low the cat’s blood sugar is going. The low point "nadir" is what you base dose changes on since you don't want the cat dropping too low (under 50).
- before bed (2-3hours after Pm shot) to get an idea of what the cat's overnight plans are. If this number is less than the pre shot test number you may want to set the alarm for a test a few hours later as this implies an active cycle.
 
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