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Ian & Oz

Ian & Oz

Member Since 2014
Hi my name is Ian,

My cat Oz who has asthma was diagnosed with diabetes a little over a month ago. My vet had me stop all dry food so he could check Oz after a month. After the month his levels were still 300-400 & the glucose in his urine was higher than could be measured. About a week ago we ( my wife & I) started giving Oz Lantus, 3 units once a day as prescribed by the vet. After a week his numbers are stil 270-400. From what I've seen online, the majority are giving two shots a day to keep them regulated. I am new to this & very concerned for Oz, I want help him the best I can. I am using Lisa Piersons (DVM), guide for which canned foods to give him & he has had no dry food. If I start to give him two shots a day would it be best to not start off with 3 units twice a day? We have a glucose meter & check him right before his shot. We give the shot after he's eaten & he eats quite a bit, is this the correct time to test & give a shot? Any information you have would be greatly appreciated.

Thank You
Ian
 
Hi Ian

I'm not a dosing expert, so I can't give you any advise on dosing, but hopefully if you can give us some more information, one of the experienced members will be able to help!

What type of insulin are you giving Oz?
Are you home testing?
How heavy is Oz now, and it's he at his ideal weight?

Did the vet give you any reasoning behind the 1 dose a day and why the 3u?

Welcome to the board! It's the most awesome place for info and help :)

Charlene
 
Hello Ian,

Welcome. You have found a place where the people are very nice and helpful.

I am no dosing expert either but my furry friend Jack was DX on 8/9/14 with a level of 634. The vet prescribed 1u of Lantus twice a day with food (standard starting regimen from what I have read in the Vet journal) . I do it @6AM and 6 PM.

From everything I have read, Lantus, in a Feline, only lasts 12 hours, thus the need for twice a day. In a human it is different.

If you get ANYTHING out of this post, I hope that it is to start low and go slow. I learned the hard way.

Jack eats a 1/2 can of wet Purina DM (only because it was Vet recommended). I will be looking into alternative food. Not because of the cost but more so whether there are the same or better high protein, low carb foods out there. A variety would probably be welcomed. He also has some DM chows but only gets a few after a shot or test.

If you look at my spreadsheet in the link at the bottom, Jack's SS. You will see his numbers and the dosing that I have been giving.

When we started on this journey, I was not seeing the results that I thought could be expected. His numbers were still in the 500's and did not seem to be budging.

I was very proactive contacting the vet asking questions and wondering if we could go higher with a dose. I snuck a couple 1.5's in before officially being told I could go to 2.0.

Being the less than a patient person, I contacted the vet again when the numbers were still not anywhere near the target of 175-250. Which is what the vet told me would be the goal.

We upped the dosage to 3.0. The vet recommended leaving that there for a while and to give him a break from testing. I could only go so long without knowing how is numbers were progressing. After all that is why I bought the meter.

Long story short, I do not feel that it was wise for me to increase the dosage, above the 2. It takes a while for his system to react to not only the insulin, but the change in BG levels that accompany it. Getting his numbers down to a level that lets the pancreas heal was important to me.

Another tip would be to really be familiar with what the numbers mean. The first time I got to 150 PS, I was in uncharted territory. Hindsight, I should have been doing the Snoopy Dance! But with 3u's that would have been too much as it turns out. Thus the reason I say I should have stayed with 2u longer.

What I have been told here is that Lantus crystalizes under the skin so not all is absorbed each time (in the initial phase) but is stored. As time goes on the crystals dissolve and get absorbed with the current shot. This is where the trouble could begin if you went too fast in raising the dose. If you meet Shelly and Jersey (wonderful person and her furry friend that went into remission) she can share her Cup Analogy. It is a good one. I think his cup is full and spills regularly which is why I have backed off the dosage.

One important factor in determining the correct dosage from the numbers you are seeing would be. How long after the shot are you getting those numbers? The Lantus action curve puts the peak at +4 - +6 hours after injection. I would suspect a test in the 2nd 12 hour period, with having been fed food, would support the higher numbers.

A spreadsheet is a must. If you do not have one, let me know. I will send you the directions that were given to me. That way the information is available to others here who might be able to help interpret them.

I have actually reverted all the way back to 1u and this morning I only gave .5 because his PS was 134. I work from home so I can check it more frequently than others but getting really low numbers is not good for Jack say nothing about me!

I will stop now as I have put a lot down here for you to absorb.

All the Best to you and yours. May your "Sugar Dances" be few.
Kevin
 
Hi Ian,

There's an absolute mine of information in the "stickies" in the Lantus Tight Regulation Group forum to get you started. Here's a link to the group's forum page:

http://www.felinediabetes.com/FDMB/viewforum.php?f=9

Start with the "New to the Group?" sticky.

You have the right test-feed-inject sequence. It's also important to get tests between insulin doses because you need to know the nadir (lowest BG level) in the cycle because it is needed along with the pre-dose BG level in order to determine correct dosing for Oz. There are lots of experienced people here who will be able to answer more of your questions about dosing.

It may take a while for you to find the hour when Oz typically reaches nadir: every cat is unique and you will need to learn Oz's pattern (by testing at different times in each cycle). Even then, the nadir time can shift around. It's great that you've made the food transition and you're home testing. :smile:

I see that Oz has asthma. Is he being treated with steroids? If yes, then that will affect his BG numbers.
 
Hi Ian and Oz,

Welcome to FDMB! My name is Shelly, and my cat's name is Jersey. We are one of the many success stories of FDMB. After just a couple of months on insulin, Jersey is now in remission. I credit the people here with her remission; they helped us every step of the way!.

It's great that you are testing Oz's blood sugar at home. That's really important in keeping him safe and finding the right dose for him. Are you using a human glucose meter or a pet-specific meter like the AlphaTrak?

I agree with what the others have said; Lantus only lasts for about 12 hours in cats, so it needs to be given twice a day, 12 hours apart. We do have a formula for calculating the starting dose for our kitties. How much does Oz weigh? (What is his ideal weight?) The starting dose is usually calculated based on ideal weight. If you do decide to give shots twice a day, I personally wouldn't give 3 units at each shot - not until we get some more experienced users in to help you determine the right starting dose. (I give lots of information - just not about dosing! :-D)

With Lantus, what we're looking for is how low a dose takes a cat. In other words, what's the lowest number in between shots? That's what we call the "nadir" and it is usually somewhere between 5 to 7 hours after the shot is given (although every cat is different). If you can get some blood sugar readings in between shots, that will really help us know how well the dose is working. If a dose takes the kitty below 50 (on a human meter) or 68 (on a pet meter), that tells us the dose is too much, and we need to reduce it. Here's some information about hypoglycemia and what to do if your kitty's numbers fall too low: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887

It's great that you have switched to low-carb canned food. That will make a big difference in helping to get Oz regulated. How often are you feeding Oz? Several smaller meals are easier for the pancreas than two larger meals. We generally try not to feed two hours before shot time. That way, the reading we get won't be influenced by food. Most diabetic cats need to eat more until their numbers become regulated.

Since Oz's numbers are still high, I would encourage you to test for ketones. You can buy ketone test strips at Wal-Mart; they're with the diabetic supplies. Just hold the test strip under the urine strip and then compare it to the color chart on the side of the bottle. If there is anything more than a trace, contact your vet since it can be an emergency situation. If it's a trace, you can always post here and ask for help.

Does Oz have any other health problems?

What questions do you have for us? (Are you overwhelmed yet?)

We all understand how difficult it is to receive the diagnosis and to start giving shots (and testing). Just take one step at a time, and we'll help you however we can!

Shelly
 
Hello,
Thank you Charlene, Kevin, Critter Mom & Shelly & Jersey,
I really appreciate your reply's!
Yes, this is pretty overwhelming, I want to do everything i can to help him & hate that it's such a delicate balance to be monitored to keep him safe. Oz weighs 9.2 pounds now, I believe he used to weigh at least 11 pounds. Oz is getting Lantus, the vet said that if he was 350 or under then he would just give the once a day dose based on his experience with other cats, trying to stay on the safe side. I spoke with my vet today & he said to start him on 2 units twice a day, does that seem like too much, should I start with just 1 unit twice a day? Is having glucose in the urine the Ketones I see mentioned? I'm using the Walmart Relion brand human glucose meter, I took it to my vet & we used the same drop of blood on my meter & his which is either an accu check or alpha Trak, that's something I need to ask, my meter read 71 points lower than his, I did this for a reference to have an idea where the level might actually be. We have four cats & I give them a 3 ounce can each twice a day, I leave the bowls out & Oz grazes alot, I had to stop the dry food cold turkey for all of them & they're still looking for more food so this is why I leave the bowls down a long time. I think Oz could use the extra food since he's lost quite a bit of weight. So should Oz eat or not eat right before his shot? I was told by the vet that he should have some food around the time of the shot. For his asthma Oz gets Flovent (inhaled steroid) through an inhaler tube, just like for children, supposedly since it is inhaled into the lungs the amount of steroid in his system is very, very low. Kevin I would really like the spread sheet, from looking at it though I'm not sure what certain things mean like the +1 +2 +3 etc. across the top. It's nice to know there are others to help, I had to go through this same thing when he was diagnosed with asthma, I had to learn from others with more experience, I thank all of you!!
 
Hey Ian

I have a big reading assignment for you :) This link gives you heaps (it is overwhelming, but bare with it!) of information about Lantus, the dosing protocol used by this board, how to set up a spreadsheet and what it all means. Im six weeks into my Lantus journey, and still very new! But these links are such a goldmine of information, and a perfect place to start - and ask questions about. The +1, +2, +3 across the top of the page represent the number of hours after your AM shot.
AMPS = AM pre shot (enter result of the test taken before shooting in the morning) PMPS = PM Pre shot. Enter any tests under the number of hours is has been since your AMPS, or PMPS.

viewtopic.php?f=9&t=18139

And here is a link all about Lantus, and the "depot" nature of how it acts - understand thy insulin (I'm still reading this and digesting!)
viewtopic.php?f=9&t=150

Re ideal starting dose - here is an extract from the tight regulation protocol - should you choose to follow it
Using a weight based formula for determining a starting dose of Lantus or Levemir when following the Tight Regulation Protocol:
the formula is 0.25 unit per kg of the cat's ideal weight
if kitty is underweight, the formula frequently used is 0.25 unit per kg of kitty's actual weight
if the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
Click to expand...
I am not a dosing expert - so please use the information above to start a question in the Lantus board about the ideal starting dose.

Here is a link to the tight regulation protocol
viewtopic.php?f=9&t=1581

Ketones - ketones are the byproduct of your kitties body burning fat in the absence of food. Because Oz's pancreas isn't creating insulin, the nutrients in the food you are giving him can't enter the cells to nourish - think of insulin as a key that unlocks the cell to take on nutrition. They are ****, but you can test for them but getting ketone test strips and testing Oz's urine.

A few things I have learnt thus far (brief compared to a lot of the users on this board!!) doing the sugar dance with my cat Java.

* Lantus likes consistency - consistency of dose, and consistency of time given
* Pick a protocol, and stick with it for a time. Either tight regulation or start low and go slow. Visit the Insulin Support group board, and read the posts.
* There are a lot of people who use the relion brand you mention - update your signature with your meter brand :)
* Oz will gain weight now he is on the juice! It just takes time, food and a bit of action from us human "beans"

The final one - this is confusing, frustrating and at times I find it to be scary. But - as with all change, you will get used to testing, you will get used to logging numbers and you will get used to having this extra sweet kitty in your life, and everything that goes with it! I promise, the balance is not so delicate - but I relate to the feeling that at the moment there is so much information to digest from people on the internet, who are giving advice that is sometimes contradictory to what you vet gives you. You know your cat best, and armed with all the knowledge the wonderful people on this board have, you will make great decisions to support Oz's health.

Read the links and ask more questions. There is no such thing as a stupid question! And i really hope I haven't' confused you.

You've got this - because all these awesome people have knowledge to help you!

Charlene
 
Thank you very much for the information & encouragement Charlene, I really appreciate it!!
Based on his current weight, I'm going to start him on 1 unit twice a day. I'll check out the links you've posted tomorrow, I know there's much to learn.

Thank You
Ian
 
Hello Ian,

I think you are right on the money as far as starting out with 1 unit twice a day. That is what Jack started out at and he is 9.2 lbs and was heavier.

Here are the directions for the spreadsheet.

Here are steps for setting up the spreadsheet we use:

1. First of all, you’ll need to set up a Google account if you don’t have one already. Here’s the link for it: https://accounts.google.com/SignUp?cont ... ageAccount

2. Once you set up your account, make sure you are signed in to it. Then click on this link: https://drive.google.com/previewtemplat ... lic&pli=1#

3. This will bring up the template that you can use. In the upper, left-hand corner of the page, it says “Use this template.” Click on that.

4. Now you have your own copy of the template. At the top, left-hand corner of the page, click on “File” and then choose “Rename.” You can now change the name of your spreadsheet (e.g., “Jack's SS”).

5. Once you finish entering the date, numbers, etc., you will need to publish your spreadsheet. Click on “File” again and then click on “publish to the web.” A little pop-up box will appear. You will want to make sure that the box that says “automatically republish when changes are made” has a check mark next to it. Then click on “start publishing.”

6. Now, you need to make sure other people can see your spreadsheet. Click on the blue “share” button on the upper right-hand corner of the page. A pop-up box will appear. Where it says “private,” change that to “anyone with the link can see” and click save at the bottom of the box. ( I never used google docs before so I had to click on the words at the top right of the pop up box (Get Shared Link). Then the “anyone with the link can see” showed up.

7. Now you have to add the spreadsheet to your FDMB account. First copy the web address that appears in the address bar on your spreadsheet. Come back to FDMB and click on “User Control Panel” at the top left-hand side of the page. Then click on the tab that says “Profile” Next, click on the tab that says “Edit Signature.” There’s a little “url” button at the top of the box where you write. Click on it. This is what will show up in the box:



Click in between the middle brackets and paste the web address for the spreadsheet that you created.

In the end, it will look something like this: https://docs.google.com/spreadsheet/.....[url] All the best! Kevin
 
Hello, Everyone! I'm Ian's wife, Erin, and he has been keeping me updated with all your responses. First of all, THANK YOU! It's a big relief to know we're not alone in this and yet sad that we've all had to come together for such a stressful, unforgiving disease.

Ian and I started the twice daily Lantus routine this morning. Last night, at 7:58pm, we tested Oz and his count was 374. We gave 1 unit of Lantus. This morning, at 9:15am, his count was 260 (the lowest we've seen, ever, since starting this, including at the vet). Now, granted, this is the first time for twice daily testing and dosing. So we're in, yet again, new territory. The count of 260 was before his breakfast and we dosed him with 1 unit of Lantus. After he finished eating, we re-checked his bg at 10:50am just for me. I was curious as to what it would be. It was 234, lower in just a little less than 2 hrs. We're curious to know what any of y'all think of this info, so far. We understand it's the very first time for twice daily dosing, we're just so nervous about all of it.

Now, my 2nd question to all of y'all is feeding. What are y'all's regimens? Do you feed twice a day? And when you do, do you give a certain amt of time before picking up the bowls so they don't graze all day till 'dinner'? Or do you just leave it out for them? Do y'all allow for healthy snacks, such as baked/ broiled, plain chicken or salmon? What does everyone think about canned tuna/ chicken in water for snacks?

I know we have a lot of questions, but I really feel that 'feeding times/ intervals' and snack times play a big part of this and are key to his bg. We appreciate everyone's advice so very much and I hope I'm not overwhelming any of you! -Erin
 
Welcome, Ian and Erin and Oz!

ian said:
Is having glucose in the urine the Ketones I see mentioned?
Click to expand...
Glucose is not the same as ketones, but ketones are another thing you might want to test about once a week or more frequently if Oz's numbers are running high. You can buy some ketostix in the diabetes section at your local pharmacy. IIRC, they run about $8-10 for 50.

ian said:
I'm using the Walmart Relion brand human glucose meter, I took it to my vet & we used the same drop of blood on my meter & his which is either an accu check or alpha Trak, that's something I need to ask, my meter read 71 points lower than his, I did this for a reference to have an idea where the level might actually be.
Click to expand...

BJ put together this helpful chart of Glucose Reference Values that explains the ranges of BG meters. In summary, all meters have a +/-20% FDA-approved variance and pet meters are about 30-40% higher than human meters when used on cats.

ian said:
The count of 260 was before his breakfast and we dosed him with 1 unit of Lantus. After he finished eating, we re-checked his bg at 10:50am just for me. I was curious as to what it would be. It was 234, lower in just a little less than 2 hrs. We're curious to know what any of y'all think of this info, so far. We understand it's the very first time for twice daily dosing, we're just so nervous about all of it.
Click to expand...
Looking good so far. Try to also grab a test around 5-7 hours after the shot as this will be the lowest point in the cycle.

ian said:
Now, my 2nd question to all of y'all is feeding. What are y'all's regimens? Do you feed twice a day? And when you do, do you give a certain amt of time before picking up the bowls so they don't graze all day till 'dinner'? Or do you just leave it out for them? Do y'all allow for healthy snacks, such as baked/ broiled, plain chicken or salmon? What does everyone think about canned tuna/ chicken in water for snacks?

I know we have a lot of questions, but I really feel that 'feeding times/ intervals' and snack times play a big part of this and are key to his bg. We appreciate everyone's advice so very much and I hope I'm not overwhelming any of you! -Erin
Click to expand...

I free-feed my two boys. I add water to their food and am able to leave it out up to 12 hours at a time. Granted, I could probably get more consistent numbers if I fed Mikey on a schedule, but since I work all day, that's not very feasible for us. :lol: One thing you want to do when you're first starting out is to remove all food two hours prior to the next shot time so the food doesn't artificially inflate the pre-shot test. Eventually, you can ignore this rule once you have more data on how food and insulin interact with Oz's numbers.

Ready for some feeding links?
 
Slight technical note to get the math right:

Human meters read about 30-40% lower than pet meters, ie 0.65*pet meter = human meter estimate

To estimate the pet glucometer, you divide the human meter by 0.65. This gives a different result than adding 35% of the human glucometer value to itself.

100/0.65 = 153.8 correct pet meter estimate
vs
1.35*100 = 135 incorrect pet meter estimate
 
Thank you very much for the information BJM & Kpassa!
We use the Relion brand human meter & I see the meter info is for the Alpha Trak.
The only reference we have is comparing our meter to our vets, ours was about 71 points lower than his, so we add the 71 points everytime we take a reading. Is there any information about the Relion meter in regards to what the actual reading is compared with a very acurate meter? I'll have to read over the Glucose reference values again to try & better understand it. I saw the information about seafood Kpassa & I'm trying to find some alternatives since I've been feeding mostly seafood based canned food. I'm using Dr. Lisa A. Piersons list of lower carb canned foods & have been sticking with the brands I've been using (& can afford). What are some of the canned foods that any of you use?

Thank You
Ian
 
Please use the readings as they are.

We use pet-specific reference numbers to compare to our human glucometer numbers and if you adjust the numbers, the suggestions you get may be incorrect.

Maybe provide these to your vet, or provide the formula: human glucometer / 0.65 = rough estimate of pet glucometer.
 
Hello, Everyone! I'm Ian's wife, Erin, and he has been keeping me updated with all your responses. First of all, THANK YOU! It's a big relief to know we're not alone in this and yet sad that we've all had to come together for such a stressful, unforgiving disease.
Click to expand...

Hi Erin,

I didn't get a chance to respond to you the other day. Sorry about that! I'm so glad that you're both here asking questions.

After he finished eating, we re-checked his bg at 10:50am just for me. I was curious as to what it would be. It was 234, lower in just a little less than 2 hrs. We're curious to know what any of y'all think of this info, so far.
Click to expand...

Actually, it's really important to get those in-between shots tests, so it's great that you did it. :-D With Lantus, we base the dose on how low it takes the kitty. Most often, Lantus takes the kitty's numbers to their lowest point around 5 to 7 hours after the shot. That's called the nadir. If you can get more of those in-between tests in that will really help us see how well this dose is working.

I know you've been overwhelmed with all of this. Have you had a chance to look at the directions for setting up a spreadsheet? If you can get one set up and get the numbers entered, it will help us see the big picture in terms of the numbers. That always help when it comes time to make suggestions about the dose.

Now, my 2nd question to all of y'all is feeding. What are y'all's regimens? Do you feed twice a day? And when you do, do you give a certain amt of time before picking up the bowls so they don't graze all day till 'dinner'? Or do you just leave it out for them? Do y'all allow for healthy snacks, such as baked/ broiled, plain chicken or salmon? What does everyone think about canned tuna/ chicken in water for snacks?
Click to expand...

I was originally feeding Jersey twice a day based on the vet's recommendations. After coming here, I realized most people were feeding multiple times a day and was told that smaller meals are easier on the pancreas. So that's what I ended up doing. I really didn't have a set feeding schedule, though. I always fed her when I gave her the shots. Then I fed several times in the 3 to 4 hours after the shots. She just pretty much told me when she was hungry, and I fed her. The only time I didn't feed her was in the 2 hours before each shot time. That way, the pre-shot numbers wouldn't be influenced by the food.

Ian - in response to your last post, we started out on Wellness Core canned food. When the cats became "bored" with it, we tried a whole variety of low-carb foods from Dr. Pierson's food chart. The cats (I have 6 now) all liked Fancy Feast the best so we fed a variety of the Fancy Feast classic pates. Most people here, it seems, do use Fancy Feast. I've also seen a lot of members feeding Friskies and Wellness.

On the snacks....most people do give their cats treats when they test them. That way, kitty associates treats with testing and cooperates. The PureBites treats are often mentioned, although Jersey didn't like those. She loved the Orijen treats, though. Just look for the pure meat treats and watch the ingredients on the label. We want the treats to be low-carb, too!

I hope some of this information helps....and keep asking questions!
Shelly
 
Hello Everyone,
We are testing Oz every two hours today & keeping track of the values, we have been giving 1u doses twice a day.
I'm still trying to fully understand how to read my meter which is the Relion brand from Walmart.
The first information I had read was from Dr. Lisa A. Pierson who said to take your meter to your vet, use the same drop of blood & compare meter readings, our meter was 70 points lower than his so we have been adding that +70 points to every reading we get.
The Glucose reference chart from what I understand says to take your meters number & divide it by .65 is this what the majority of you do? It seems that no meter is exactly accurate, I'm trying to gain my confidence & know where Oz's BG level actually is.
The last reading we took was 294 on our meter, when we add 70 we get 364. Using the divide by .65 formula we would get 452.30.

Thank You
Ian
 
Great job getting some tests in! There is absolutely no need to do any math/calculations. Just let us know the actual numbers you get. Since you're using a human meter, "normal" numbers are between 50 and 120. (I thought BJ's chart had both human and AlphaTrak numbers on it. I'll have to go back and look at that.) I know your vet uses a different meter, but it will be important for us to see the actual numbers you get on the human meter. We already take into account that human meters tend to read lower than pet meters. Hope that makes sense.

Can we help you get a spreadsheet set up and help you figure out how to enter the numbers on it?

We're a Fancy Feast household right now, although we've also used Wellness Core and Friskies Special Diet.

Good to see you!
Shelly
 
While you can do a rough conversion back and forth between human and pet glucometers, it isn't necessary, nor desirable.

Nor does 1 drop of blood tested on 2 different meters give you a conversion; that will change with nearly every single test done due to the +/- 20% allowed variation from what a lab would get.

Please just report the actual numbers you get and make sure your signature identifies your meter type.
 
Generally, we increase by 0.25 units at a time so we don't miss the optimal dose for the cat. No OTC syringes measure more precisely than 0.5 units, so you have to eyeball it on the syringe.

Given the nadirs you are seeing, along with the amount of drop from pre-shot, it may be OK. Just noting it for reference.

Are you interested in following the Lantus Tight Regulation protocol? In addition to getting pre-shots, they suggest testing around the nadir (between +5 to +7) and before bed whenever possible and at least weekly. That can be a lot for one's schedule, but it is a research demonstrated protocol to get diabetic cats off insulin.

If that doesn't work well for your schedule, the Start Low, Go Slow protocol holds the same dose for a week at a time, with a curve or nadir test at least once a week.
 
Great job getting the spreadsheet up! That helps us a lot.

I know you had some concerns about how to deal with the numbers. Here's an excerpt from BJ's chart:

< 40 mg/dL (2.2 mmol/L) {< 57-67 mg/dL for an AlphaTrak}
Click to expand...

That very first number you see (40) is the number from a human meter. The next number you see (2.2.) is also the number from a human meter - it's just the standard measurement used in most places outside of the U.S. That final set of numbers (57-67) would be numbers on an AlphaTrak. I know all of that's really confusing. As long as you give us the actual readings from your meter (in this case, a human meter), we'll be able to tell what they mean in terms of dosing and how the kitty is doing.

Great job with the curve you did yesterday, too. That's fantastic information to have. One suggestion I would have.....try to get at least one test in between each shot. Since Lantus dosing is based on the lowest point in the cycle, having at least one test per cycle (and grabbing it between 5 to 7 hours after the shot, if you can) will be especially helpful.

I actually used the Tight Regulation (TR) protocol that BJ mentioned in her post. That approach does ask that you always get tests before you give insulin and that you get at least one test in between each shot. In fact, many people using the TR protocol don't do true "curves" very often like you did yesterday. Although curves can be very helpful, they can't always tell us the full story because of what we call bouncing. Here's some more information about bouncing:

julie & punkin (ga) said:
BOUNCING

Here is an example of a bounce from someone's recent condo:

you can spot a bounce this way (this only took me 6 months to learn and a bunch of people explaining it! i'm a slow learner!)

yesterday morning you had a 215 - then it went 235, 271, 270, and then 308 this morning - basically straight up. no curve. and then look backwards in the ss and the night before was that sweet little 148 12 hours earlier.

if you imagine that night-time cycle, starting at 148, kitty probably went down in a nice little curve, hitting something under 100 mid-cycle. that lower-than-usual number would've shocked her body. they get accustomed to whatever range they're in, and any sudden dip lower can set this off.

"HELLO WE"VE GOT A 911 HERE- KITTY'S GOING DOWN!" yells Mr. Liver. Fortunately, mr liver has a storehouse of counter-regulatory hormones and stored sugar (in case kitty needs a little nommy sweets in the middle of the night) and when Kitty gets into a range of numbers lower than usual, Mr. Liver lets loose with the sugar and the hormones and sends Kitty on a rocket to the moon. this is the cat's body's protective mechanism to keep the cat from becoming hypoglycemic. unfortunately, mr liver doesn't seem to know that anything above 40ish isn't a crisis and it will do this regardless of the range of numbers, even at 200 if the cat has become accustomed to 400.

A second cause of a bounce is if a cat drops very quickly. 100 points in an hour, for example, regardless of the range the BG number is in, can cause a bounce as well.

So, what to do now? don't increase the dose because of these higher numbers. once this bounce clears, which can take up to 3 days of high numbers if mr liver is super-active, then if you had increased the dose, it would be too high. you are entering the phase of treatment that we say requires "Patience Pants." when you think you're seeing a bounce, you have to wait it out, then you can see what the dose really does. You will know the bounce has cleared when you start seeing numbers you were seeing before - like that 148 again.
Click to expand...

If you happen to do a curve on a day when the kitty is bouncing, you might think you need to raise the dose when you actually don't. That's one of the reasons why we recommend getting mid-cycle tests every single day. As BJ mentioned, we also recommend increasing in small amounts - like .25 units at a time. Sometimes, that extra tiny bit of insulin can be all the kitty needs and increasing by more than that may be too much insulin for the kitty. (It still amazes me how much of an effect even a "breath" of insulin can have on a cat.)

Are there questions you have that we can answer? Questions that you've already asked that we didn't answer fully? Please let us know how we can help!
Shelly
 
Hi BJM & Shelly,
Thank you for your replies.
Originally our vet had Oz on 3u once a day, then said to go to 2u twice a day based on his levels.
I thought 2u might be too big of a jump for twice a day even though I have nothing to base it on other than my concern for dropping
him too low. Erin & I decided on 1 u & did that for five days, seeing the levels we decided to go to 2u last night, he also received 2u this morning. After reading your posts it made us want to lower the dosage a bit, so we went to 1.5u tonight. I know it's not in the .25 increments you stated but it's lower than 2u. I'm hoping having two doses of 2u then the 1.5 won't confuse his system too much? So much to learn & so many variables. Thank you for the Bounce information also. We've updated his chart this evening.

Thank You
Ian
 
What may happen is that the depot may fill faster and possibly a smidge too high, then settle down to stabilize. The depot is what Lantus creates when it is injected. It crystalizes and then slowly dissolves. Just be watchful around the nadir (+5 to +7 hours post shot usually) for any unusual behaviors.
 
Hi KPassa,
Thanks for asking!
He's doing better, the numbers seem to be very slowly getting lower, but still some go a little higher.
I think a little while longer & we'll go to 2 units. Our syringes are in 1 unit increments with a half marks also.
I'll try & update his spread sheet on here later this evening.

Ian
 
Glad to hear he's doing better. Please let us know when you get his spreadsheet updated. :-D
 
Dose increases for Lantus are based on the nadir, the lowest glucose level between shots. That is often around +5 to +7 hours after a shot. You get mid-cycle tests when you can - before bed tests, or on a weekend or day off, or even sometimes setting an alarm in the middle of the night.

With no mid-cycle data, you have no way to know how low he is going, so any increases should not be made.
 
Hi All,

I've added our first mid cycle readings at +5 & +7, from today. It seems at +7 it's going up.

Ian
 
Keep in mind that the FDA allows meters to read +/- 20% from what a lab would get.

The readings you got are higher than the desired numbers, though, so you could increase by 0.25 units. Just stick to the same dose for a minimum of 3 full days (according to the Lantus Tight Regulation Protocol), unless he drops below 50 mg/dL, in which case, he earns a reduction. If you prefer to go slower because you aren't able to get much mid-cycle testing, you might follow the Start Low, Go Slow protocol and only increase doses after a minimum of a full week on a dose.
 
Hi Ian and Erin,

I didn't see any numbers on Oz's spreadsheet for last night or today, so I hope all is going well for you. As BJ mentioned, if you can get at least one test in each cycle, that would be really helpful since we base the dose on how low the numbers get in the middle of the cycle. It's certainly possible that Oz needs more insulin, or it could be that the numbers you saw yesterday (e.g., from 341 to 261) were a sign that Oz sliding down from a bounce. That's where the extra tests would be especially helpful. You don't always have to get a test at +5 or +7. Even if you can only get a test in at +3 or +10, that will really help a lot. For instance, can you grab a test right before you go to bed? Or when you walk in the door from work? Whatever you can do will be helpful.

Let us know if we can help you!
Shelly
 
Hi Shelly,
Thanks for your reply.
I've updated Oz's spreadsheet through this afternoon.
I took a +5 & +7 reading again today.
We'll try & do as many as possible to get a better understanding of where his levels are.
We've been at 1.5u for six days now & thinking about bumping him up.
As BJM said drawing up those .25's increments will have to be eyeballed basically, our syringes are half units & units.
By what you're seeing so far from his spreadsheet, where does Oz stand on his levels?
Am I correct in using the, divide my levels by .65 calculation to get a more accurate level?
If I take 267 & divide by .65 I get 410.77 this is how I understand BJM's method.

Thanks again
Ian
 
Please report the actual numbers you get; do not convert.
The spreadsheet's color coding is expecting the original numbers.
 
Great job getting those tests in today! :-D That was one flat kitty, which I know is frustrating for you to see. One thing I've learned from the brief time I've been here - when you see flat yellows like what you saw today, you may see an "active" cycle after that (meaning you see quite a bit of movement in the numbers). Every cat is different, but it always amazes me how many times it happens.

Am I correct in using the, divide my levels by .65 calculation to get a more accurate level?
If I take 267 & divide by .65 I get 410.77 this is how I understand BJM's method.
Click to expand...

Nope - just record the actual numbers you get from your meter on the spreadsheet. Don't do any calculations. We know you're using a human meter....and we automatically look at the spreadsheet with those numbers in mind. On a human meter, this is basically what we're looking for:

Under 50 - That's our "take action" number where the kitty's glucose is too low. If kitty falls below 50, we feed high-carb food (and reduce the insulin dose).
50 to 120 - These are great numbers and this is where we want our kitties to be.
120 - 200/250 - These aren't "terrible" numbers; they're below renal threshold, so organ damage is supposed to be limited. Different sources give different numbers on renal threshold; some say 200, 250, 280....there's just not much agreement, it seems.

The scale above is based on the actual numbers you get from your human meter. Again - no calculations necessary. Just compare the numbers you see on your meter to the numbers above.

By the way, I know we're not to that point yet, but if you ever do get a low number at pre-shot time (e.g., less than 200), we encourage you to post here and ask for advice. It's usually safe to give insulin, but we like to make sure we can help members through those first few times shooting lower numbers.

Remember - you don't have to do a full curve every day; just getting some "here and there" tests will help and mixing up your test times can help, too, (e.g., a +4 one day, a +7 the next, etc.).

In terms of the dose....I know "a lot" (relatively speaking) about how the insulin works, bouncing, testing, feeding tips, home meters, etc. I'm not one of the most experienced users here in terms of analyzing the dose, though, and prefer to leave specific dosing advice to those who are more experienced than I am. I definitely know the limits to my knowledge and don't want to steer anyone wrong in terms of the dose and usually only chime in on the dose when it's obvious the dose needs to be decreased.

I know the meter issues/numbers are super confusing. Just write down the actual numbers you see on your meter, though, and we'll know what they mean. If the numbers are based on calculations you've done, I would encourage you to go back and change them to the original numbers you got from the meter. That might make a difference in dosing advice.

I'm sure you are really frustrated right now. You're giving insulin and you just keep seeing these pinks and yellows on the spreadsheet. It may take a little time for you to see progress with the insulin. With Jersey, we had weeks of bad numbers before everything finally fell into place. After that, she couldn't seem to go off insulin fast enough. Hang in there; you really will start to see better numbers.

Shelly
 
Hi Shelly,
The numbers on the spread sheet are the actual numbers from the meter.
I'm pretty sure I understand the formula correctly - take your meter reading & divide by .65, I had asked this several times but I think everyone misunderstood my question, I just wanted to know for myself how to calculate a more accurate reading.

One thing I've learned from the brief time I've been here - when you see flat yellows like what you saw today, you may see an "active" cycle after that (meaning you see quite a bit of movement in the numbers).
Click to expand...

What sort of movement happens Shelly, is it usually up or down or unpredictable?
Should we wait before going up on the dose because of the flat yellows or is it ok to increase?

Also I've been wondering about giving food/snack after a shot, right now he gets a shot at 9:00 A.M. & then food in the morning & the bowls are left out until the next feeding (we have a total of four cats).
The next feeding time is 6:30 P.M. & the bowls are left out, we give Oz his second shot at 9:00 P.M. is it necessary to give him a snack/food right after the shot? We've been giving him something after the night time shot thinking it's important but not really sure.

Thank You
Ian
 
Thanks for confirming that the actual numbers are on the ss.

I just wanted to know for myself how to calculate a more accurate reading.
Click to expand...

Okay, I guess I'm confused (which happens easily :lol:). More accurate in what way? Are you trying to figure out how the readings you're getting on the human meter might compare to the readings that you get at the vet's office (on a pet meter)?

Lantus cycles....An active cycle means that the numbers go down. For instance, Jersey one time started at 370 at shot time and went all the way down to 88 five-and-a-half hours later. By the next shot time, she was back up to 166. That was an "active" cycle. Another time, she started at 365, was at 338 four hours later, and ended the cycle at 324. That was not an active cycle; she was bouncing during that cycle so her numbers really didn't move much. When we're looking at flat cycles, we don't always know if it's because the dose needs increased or if it's because the kitty is bouncing from lower numbers in a previous cycle. Both situations can look the same (and that's where those extra tests can help us). So.....when I mentioned an active cycle after a flat yellow cycle, I meant that the numbers go down.

I'm glad you brought up the food issue. Most people here actually recommend that you do not feed two hours before each shot time. That way, the pre-shot numbers you get won't be influenced by food. Then feed at shot time. Most of us will test the blood sugar, feed, and then give insulin (all within 10 to 15 minutes). Many people here feed small meals throughout the early part of the cycle. For example, they feed at shot time, at +1, +2, and +3. Their kitties get lots of small meals. I also fed Jersey lots of small meals, although I also gave her meals later in the cycle. For example, I fed at shot time, +1, +2, +4, +6. I pretty much fed her whenever she wanted - except for the two hours before shot time because I didn't want food-influenced numbers. Of course, you do need to feed if numbers drop too low (under 50) at any time in the cycle.

If you decide to move to something like what most people here do, you wouldn't feed between 7:00 and 9:00. You would then feed at 9:00 (and could leave the food down for several hours afterwards).

Like I said, I'm really not experienced enough to suggest raising the dose. I think that's something that you'll have to decide based on some of the other dosing advice you've gotten here, your own research, and your vet's suggestions. I'm really not trying to ignore your question. I'm just not experienced enough to feel confident in an answer.

Okay, so I hope I've been able to answer at least some of your questions. If not, let me know and I'll try again. (Or I'll find someone who can answer your questions! :-D )
 
Hi Shelly,

Are you trying to figure out how the readings you're getting on the human meter might compare to the readings that you get at the vet's office (on a pet meter)?
Click to expand...

Yes, that's why I wanted to know.
The first bit of info I saw was from Dr. Lisa Pierson who said to take your meter to your vet & compare the two & make note of the difference & use that as your guide. So our meter was 70 points under what our vets meter read & we went by that.
I had assumed that since Dr.Pierson had been doing her research for over a decade that the meter comparison was the way to go, & then was told here about the .65 calculation. I'd like to know as much as I can in order to better help Oz, so I like to know what you & others get from seeing his levels, I guess a better way to say it is, I want to learn what you know.
I think you mentioned that you give Fancy Feast to Jersey, which flavors do you get. I give Oz, well they all get the Fancy Feast Classic dinners, all of the Seafood based cans & also Turkey & Chicken. I know he's not supposed to have the gravy versions because of the high carbs. I'm using Dr. Piersons canned food list but wondered if maybe you knew of some Fancy Feast cans that weren't listed.

Lantus cycles....An active cycle means that the numbers go down. For instance, Jersey one time started at 370 at shot time and went all the way down to 88 five-and-a-half hours later. By the next shot time, she was back up to 166. That was an "active" cycle. Another time, she started at 365, was at 338 four hours later, and ended the cycle at 324. That was not an active cycle; she was bouncing during that cycle so her numbers really didn't move much. When we're looking at flat cycles, we don't always know if it's because the dose needs increased or if it's because the kitty is bouncing from lower numbers in a previous cycle. Both situations can look the same (and that's where those extra tests can help us). So.....when I mentioned an active cycle after a flat yellow cycle, I meant that the numbers go down.
Click to expand...

These kinds of things make me nervous, it seems hard to know what will happen, doesn't seem very predictable with Bouncing & cycling. Is there a point where things become more stable?

Thank You for your responses!

Ian
 
Hello Ian, Erin and Oz,

I am Kevin and I started this journey 45 days ago with Jack. I tested Samantha with Jack's meter (AlphaTrak) and knew she was diabetic before I brought her to the vet.

Jack started out very high. 634 at the vet. It may have been inflated due to stress but he was still higher than Samantha was and he needed a lot of attention as neuropathy was present. I have been giving Jack some Zobaline. It is B12 and has been suggested it helps with the nerve damage. The Vet approved giving it to him and I really feel that it has helped him. His numbers are in control (which is the prime directive) but anything I can do to help Jack walk better is what I will do.

I see by the spreadsheet that you have been consistent dosing @ 1.5 over a week and the numbers do go down but not low enough. I do not see anywhere where Oz even went into the green.

I would think that if you presented these numbers to your vet that he/she would suggest an increase in the dosage. I do not see that Oz is anywhere near being low.

IMHO, I would increase the dose to 2.0 and hold that steady for at least 6 cycles (3 days) and still monitor at +4 & +6 or +5 & +7, to obtain the nadir (lowest point) for the cycle. I would think that you should then start to see some blue creep into your spreadsheet.

All the best,
Kevin
 
Ian,

I would create a new post for new questions and the continuation of this thread.

You can post the link to this thread at the top of your new post by copying the link from your browser, hit the URL button and paste it right in the middle of the ]url]. I have done it here for you ...diabetes.com/FDMB/viewtopic.php?f=28&t=124970

This way people may be more inclined to read it (its new), and now that you are no longer JUST "New Member with Questions", you have more information to give and will need some more specific answers.

A post for 9/22 might be something like AMPS 267 +5/242, +7/261 Dosage Increase?

Just trying to help
 
Just report the numbers you actually get and don't worry about conversion. The 0.65 is an estimator only for batches of meter comparison tests.

Meters in the US can vary +/- 20% from what a lab would get, and human meters may run 30 - 40% lower than pet meters. Those are averages, not specific meters. And when it comes down to it, if its over the renal threshold, roughly 240 mg/dl depending on reference source and cat's renal status, it is too high and an actual number really doesn't matter.
 
Thebudster77 said:
IMHO, I would increase the dose to 2.0 and hold that steady for at least 6 cycles (3 days) and still monitor at +4 & +6 or +5 & +7, to obtain the nadir (lowest point) for the cycle. I would think that you should then start to see some blue creep into your spreadsheet.
Click to expand...
I agree that from the numbers you've been getting, you do have a bit of room to increase, however, I would suggest only going up to 1.75u initially since you are getting numbers below 300 and you're just now starting to get some more mid-cycle numbers in. What do you guys think about an increase?
 
Hi,
This morning I checked Oz's BG level & it was 524 the highest reading we've had so far, there was food still out & maybe he had eaten before I got up to check him & give his shot (which at the moment is 1.5u) but the food is always out at that time. I gave him his shot at 9:00 A.M. I took up his food at noon so that he wouldn't have anything to eat for 2 hours,I just did a +5 check & now his level is 132, lower than we've ever seen. Anyone have any ideas as to what may be happening? Maybe each time we've done his BG level test he's had some food in his system giving the 200-300's numbers? I'm concerned at the moment about the 132 reading, I gave him some food just now after the check.

Any help would be greatly appreciated

Ian

(I posted this as a new topic as well)
 
BJM said:
Slight technical note to get the math right:

Human meters read about 30-40% lower than pet meters, ie 0.65*pet meter = human meter estimate

To estimate the pet glucometer, you divide the human meter by 0.65. This gives a different result than adding 35% of the human glucometer value to itself.

100/0.65 = 153.8 correct pet meter estimate
vs
1.35*100 = 135 incorrect pet meter estimate
Click to expand...

Ok so when determining PUMPS level, Fearless had BY of 135 on the Relion micro meter at +11 or her PMPS. Do divide 135 by 0.65 and put that number on her spread sheet or do I put 135 on there? Does this mean Fearless actually had a PMPS BG of 207?
 
Enter the actual readings you get.

The formulas can only estimate, as meters may read within +/- 20% of what a lab would get, so you can only estimate for that range, not for a single point. Meters are intended to give you clues about trends, not to be precision instruments.
 
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