? Need Opinions on Frodo's SS

[Nancey]

Since I posted last, Frodo has been in for a dental (tooth extracted, infection cleared up) and we decided to switch him to Lantus. He was on Prozinc prior and I felt comfortable adjusting his dose if he was low at a PS number. But Lantus has me a little off balance. We are seeing more yellows and blues since he started the Lantus, but still just not sure. Could someone please look at his SS and let me know your thoughts. Frodo is a snacker, so his numbers seem to be everywhere, in the evening I can control him more, but when I get home from work I have no clue when he ate last. Should I increase his dose again? Plus he seems to be throwing up a good bit, especially when I see the lower 100's like the day before. Yesterday when I got home from work all their bowls were cleaned out. So after testing they get fed, he ate what was in bowl and threw it up, 3 times before stopping and then one more time before bed. And it isn't a bunch of food, it looks like watered down food, or just thick food colored water. He threw up this morning also, same thing watery stuff the color of his food. He is acting alright, other than he seems to be hungry a lot, and very picky lately about what he will eat. And when he hits those 300's he is grumpy. Not sure what to do with him. Any advice is really appreciated.

 

[Larry and Kitties]

Strange, except for the 20th and 21st, the curves have been essentially flat. Wha tthat happens and then y get low number like the 20th and 21st, that itypically indicates the dose of 2.15 is too high.
I would try reducing the does to 1 1/2 or maybe 1 3/4

 

[Wendy&Neko]

Lantus works quite differently than Prozinc. When you shoot the same dose into a lower number, you end up with a flatter cycle. If Frodo gives you a lower number at night or on a weekend morning when you can monitor, try giving the full dose and see what happens. You might want to gradually lower the number where you do that. I see you've shot a 179 before, so that's a good place to start. Then slowly lower the number you are comfortable with. Last night for example, you could have given a half dose to get some insulin in. Lantus works best with consistent dosing.

Also remember that Lantus is dosed based on the lowest number of the cycle or the nadir. If you could occasionally get an out the door/in the door number during the day and a before bed test at night, it will fill in some of the gaps. From what you do have, it doesn't look like too much insulin to me.

As for the vomiting, are you feeding small meals spread out over time? Some cats like to scarf and barf if it's too much food at once. You can get bowls that slow them down, or I've heard of people putting clean golf balls in the food dish to slow them down. If it's not scarf and barf or hairballs, you might want to schedule a vet visit.

 

[Critter Mom]

Does Frodo go for long-ish periods between meals (e.g. >3 - 3½ hours)? If yes, then it might be excess stomach acid that's making him throw up. If that's the case, breaking up his food allowance into smaller, more frequent meals can help with that. Also raise his dish if possible. A timed feeder (e.g. Petsafe 5) can be a godsend for scheduling feeds while you're out or asleep.

I agree with Wendy about the vet visit.

 

[Nancey]

Okay I think the dosing is where I am having the problem. My vet started him out at 2 units since that is what his dose was on Prozinc. Then we did the dental and found the issues, did the antibiotics and now he is good. So should I drop the dose as Larry is suggesting and if I do, do I drop a little at a time or just go ahead and drop it to 1.5 or 1.75. I did wonder if I should have started him at 1 unit and gone from there, since he had the dental issues and his numbers were so messed up on Prozinc. Wendy should I try shooting at lower numbers now or after the decrease? I had remembered reading Lantus works better when consistently given, just the lower numbers kind of scared me since I am new with Lantus and by the time I tested and got a higher number seemed to late to give him anything since I no it is long lasting. So the thought is to high a dose is making him flat line on his BG's right, which is what I wondered, but wasn't sure.

As for the throwing up, it has stopped. This last time was the night of the 20th when he was 128 at PMPS, and he did eat rather quickly, and it came up just as quick. And from looking at the bowls it did seem they had been sitting empty for several hours. And then as you see his numbers just went up from there into the 21st at AMPS. They have been really picky with the food lately. Like they are tired of what they are being fed so I have been trying some different foods. I free feed all 7 of them. So food down after morning test, 6ish, shot at 6:30. Then I fill the bowls up before I leave for the day. I do have a timed feeder I could add some extra in there just in case they want a little more. I have noticed to see a lower number before shooting he has to go several hours with no food, not just 2, even if he Tiki Kat which is no carb for the most part. When I get home it is test at 6ish, feed and then shoot at 6:30. The I put food down at bedtime, 9:30 - 10. I can get up multiple times through out the night just depends on how often my 16 year old wakes me for food (whole other story), but she is in a room to herself and on prednisolone . So I watch the bowls when I do get up and will put some extra down if it is gone before 2AM as I have noticed anything after that they just leave it, or they wait to eat it right when I come down to fix breakfast.

Sorry for this being so long.. I am just lost with this, I just can't seem to figure how to get Frodo's numbers better. He is a big baby of a kitty, he hates being picked on and one his brothers has really been giving him a hard time since our dog passed away in May. It upsets Frodo so much he will poop right where he is at.. breaks my heart, he just wants to be left alone. Anyway.. thanks to those who have replied and I appreciate further input on my update.

 

[Chris & China (GA)]

I don't see anything to really suggest that you need to drop the dose at this point, but you are holding onto the same dose too long.

Have you decided if you're going to use the Tight Regulation Protocol or the Start Low, Go Slow? The TR protocol gives the better chance at remission, but does require a more aggressive approach and you'd need to be able to test at least 4 times a day (before each shot and 1 mid-cycle during the AM and a "before bed" on the PM) and increases are made every 3 days (if needed) Start Low, Go Slow is less aggressive and increases are only done once/week after a curve has been run (testing every 2 hours for 12 hours or every 3 hours for 18 hours)

If you hold onto a dose that's not working for too long, glucose toxicity can set in which makes it that much harder to get to that "best dose" that will work best.

You also need to get comfortable with "shoot low to stay low"....As long as you have all the supplies you need (strips, high carb food, Karo/honey/syrup) and can test, you'll want to shoot those lower numbers.....First we start at shooting if they're at 150 or higher, but gradually you learn to shoot lower and lower numbers. Most of us here that have enough data on our cats will shoot anything above 50

Lantus works the best when it doesn't have to "pull down" those higher numbers

Look over the protocols and let us know which one you are going to follow (and please add that info into your signature line so we don't have to keep asking)

It might be good for you to move over to the Lantus/Levemir Forum too so you'll get the most experienced eyes watching out for you and Frodo. Everyone there uses either Lantus or Levemir so we're used to working with those insulins

 

[Nancey]

@Chris & China - Thanks for the input. I have 2 questions: Should I leave his dose where it is at for now? And do you always give the same dose regardless of the preshot number or do you adjust the dose?

Also, I have been reading between the two protocols, my preference would be the Tight Regulation, and I guess I am going to have to go with Start Low, Go Slow as the only time I can get a mid-cycle AM test is on the weekends. I leave the house around 7:30 AM and do not get home until close to 5 PM. So in the morning I can get a 5 AM, then 6 AM AMPS, and one more before leaving the house, so around 7:30 or 7:45. Weekends and evenings/nights no problem getting numbers at mid-cycle. Which would you do based on when I can test?

I will start posting on the Lantus/Levemir Forum also. Thanks

 

[Chris & China (GA)]

Is there anyone (friend or neighbor) who could stop by during the day and check on him? TR is possible with a full time job though! Read through this "Is TR possible with a full time job" thread and see if any of the suggestions there would work for you

Yes, you always give the same dose both AM and PM (unless he earns a reduction) Lantus works best when it's given consistently. Another one of the big differences between ProZinc and Lantus is that Lantus is dosed based on how LOW it takes them, not the Pre-shot number like it is with ProZinc.

I think you could probably go up to 2.5, but why don't you post over in the Lantus forum and say something like "opinions on dose needed" in the title and let's see if we can get some other opinions. You can also use the ? prefix in the title to get more eyes on your post

 

[julie & punkin (ga)]

Hi Nancey! I saw your post on the Lantus/Lev group, but it looks like everyone is responding here, so I will too.

I think the biggest thing you could do to change his spreadsheet is to shoot the full dose into those lower preshots. They are a gift! An opportunity to lower his whole range of blood sugar and help it flatten out! Personally, I wouldn't change his dose at the moment because it looks like it's getting him into at LEAST the low 100's, possibly lower. With Lantus and Lev, the low numbers trump all the high numbers when it comes to making dose decisions. Here are a couple of resources that can help you understand what happens when you shoot low with Lantus and Lev:

Shooting Low This one includes some links to spreadsheets so you can see what happens when you shoot a lower preshot, along with explanations of what to look for. It also includes a link to the Tight Regulation Protocol sticky about becoming data ready to shoot normal numbers. Please do look at those.

Shooting a Dropping Number - look at post #6

When you have a lower preshot, and you can monitor the hours afterwards, it will be another opportunity for you - once you've had one, you're likely to have another one. Please post on the Lantus/Lev group and ask for advice. If someone is able to stay with you to help you deal with any low numbers, they will. While you are waiting for someone to reply, don't feed Frodo, and retest him in about 30 minutes.

The other main change I would make if I were you, is to get at least one mid-cycle every day, either in the day cycle or before you go to bed. Lantus dosing is based upon how LOW a dose makes a cat go, so finding that low point somewhere in the middle-ish of the cycle (not exactly +6, vary the times around) will help with deciding what needs to happen with the dose.

But really, I think the skipped shots are setting you back and getting the hang of shooting lower numbers will really help you help Frodo.

I'd encourage you to post regularly on the Lantus/Lev group and we can help you learn how Lantus works in Frodo.

 

[Nancey]

Thank you to everyone for replying, I read the information Julie suggested, I think I have read it several times already and it just doesn't stick in my head. I did shot Frodo this morning his AMPS was 166. I updated my title in the Lantus/Levimer forum to show that and ask for input. Plus I update the SS from yesterday to today. I will leave his dose where it is at for now, and not skip anymore doses. Like I stated before it is just a different world to get use to with Lantus compared to Prozinc. With everyone's suggestions and help, I am feeling better about shooting lower.


Chris forgot to say that no I do not have anyone to check on him. We have no family here, it is just me and my husband. If I scheduled with my petsitter she could pitstop, but I don't need her to stop everyday and she does not test so not much help I don't think. I really need to get her trained to test.
Thank you..

 

[BJM]

Sometimes it can help when studying a new topic to take each sentence and write it in your own words. This helps you remember it in a way that makes sense to you.
Then, you can check with us to see if you understood it correctly.