New: Struggling with Lantus & Vet Recommending Glipazide

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weeble

weeble

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Hi Everyone,

Hopefully I've successfully attached my google spreadsheet which should cover all the ups and downs I've been through since my cat was diagnosed on 6/9 of this year.

The long and short is I'm not particularly confident in my doctor's recommendation as I've learned some game-changing information through this site, specifically the "storage shed" and injection locations, as well as seeing the glipazide is not particularly popular here. I'm hoping I can get some feedback on my spreadsheet because I seem to keep getting painfully close, only to see the whole thing fall apart.

I have another appointment with a doctor on the 16th of this month, a doctor who came highly recommended from people that are expert in sick cats and have had multiple with diabetes.

Thanks everyone!

http://spreadsheets.google.com/pub?key=0AtFgfT__046_dFJBRVZkR09NZFc4bWpNRXFndmJITVE&output=html
 
Re: New: Struggling with Lantus & Vet Reccomending Glipazide

Welcome to FDMB!

We use Lantus, but I'm way too new at it to be able to help you with the insulin. I would suggest cross posting on the Lantus ISG in order to get some more experienced folks to take a look at your spreadsheet. I'll post over there in the meantime and try to get some eyes for you.

I'm happy to see that you are home testing, good for you! One thing I will suggest is that you need to do more testing in order to gather the data you need to regulate your kitty. At minimum, you need to test before every shot, and try to get at least one mid cycle test between the AM and PM shots. You will see that most of the Lantus folks generally do much more testing than that. If you are having issues with testing, please start a new thread with something like testing help needed in the title, and people will try to help you with it.
 
Re: New: Struggling with Lantus & Vet Reccomending Glipazide

Thanks for your reply. Off to an interesting start--I actually thought I was posting it there. How do you crosspost?
 
Re: New: Struggling with Lantus & Vet Reccomending Glipazide

That's a good question! I've never done it, myself! :lol: If you highlight and copy the text from your original post, then go to the lantus group and click on new topic and paste the text in the box, that should work. Just fill in the subject again and you should be all set to submit.

I did post a link over there, so hopefully someone will be along soon to help you. :smile:
 
Re: New: Struggling with Lantus & Vet Reccomending Glipazide

Hi there

welcome to the FDMB.

Spreadsheet set up looks fine. Good job on the notes, lots of info in there.

In the Lantus forum you'll find plenty of information stickies about how Lantus works.
Have a re-through when you have a chance.

Looks like you are missing some shots and mid cycle numbers. Pre-shots are encouraged. As well as mid cycle spot checks.
I see one note where it says you have some difficulty with the testing. It does get easier.

So do keep trying. Those numbers are key to seeing how your kitty is doing on a consistent schedule of Lantus.

And yes, you can open a thread in the Lantus forum to get assistance how your spreadsheet numbers are going.
 
Re: New: Struggling with Lantus & Vet Reccomending Glipazide

I spend most of my time over on the Lantus board but a few people asked that we stop by. Welcome to FDMB!

I'd encourage you to take a look at this information on glipizide. The last paragraph notes,
One of the most important cautions with the use of this medication is that by increasing the release of insulin, glipizide also increases the secretion of other proteins in the pancreas. It is generally abnormal protein deposition in the pancreas that caused the diabetes mellitus in the first place, thus the use glipizide may lead to progression of pancreatic destruction. For this reason, we recommend glipizide as a last resort when insulin administration cannot be given or for a select few cats who are sensitive to insulin secretion.
Click to expand...

This is why glipizide isn't popular here! Cats have the potential of going into remission. The use of glipizide is likely to take remission off the table.

The notes on your spreadsheet are helpful. However, was your vet switching around insulin? Have you been using Lantus consistently and at one point, your vet was giving Humulin N?

From the standpoint of dosing, it's important to get both pre-shot tests as well as mid-cycle spot checks. With Lantus, dosing is based on the lowest point of the cycle (the nadir) and not your pre-shot test. Lantus also likes consistency. Skipping shots has an effect on the shed so you lose the cumulative effect that allows Lantus to be a gentle insulin with overlap between doses. If you are getting numbers that are too low for you to shoot comfortably, lowering the dose so you can shoot twice a day is better than shooting a larger dose once a day. Lantus is a twice a day insulin in cats.

With regard to your cat's IBD, if you've not already found the website authored by a veterinarian, Dr. Lisa Pierson, it is a wealth of information on feline nutrition. There is particularly good information on IBD and food on the website.
 
Thanks for coming over--it was my intention to post there, but somehow ended up here. I was actually considering re-posting there, but I didn't want to have to get off on the wrong foot with a bunch of double posts. Should I re-post?

Yes, I did read that. Which is why I didn't go pick up the medicine and posted on here. And this doctor (the 2nd) was more aggressive than I was comfortable with (high starting doses and no acclimitization before doing a curve) and switching insulins around. I went back to the Lantus after consulting with my home doctor. The 2nd didn't know about rebounding or the "storage shed". I think she means well, but is impatient and not particularly knowledgeable about this insulin.

The thing about checking my cat--I kind of like to save it up because her veins are extremely small and it is difficult to get a hit. Obviously, this is unpleasant for her. And it's not just me or her ears--I've seen doctors struggle to get blood from her neck. I do think I need a better pen--something I'm going to get tomorrow. So I don't test for sure when she's peeing a lot, the one consistent sign of high BGs. I think the big problem is, like you mentioned, I keep missing shots--lately due to low numbers at her nadir, which come 12 hours after the AM shot.

So, just to be clear, from looking at my chart, you think I should keep trying with the Lantus as well, right? Just get more numbers and be sure maintain consistency--even if that means having to give a lower dose?
 
Have you tried testing from her paw? A warmed up rice sock and rubbing tends to get the blood flowing and makes getting it much easier. I had trouble in the beginning and it took me several tries to get enough. Now its first jab every time. :lol: Having the info is really helpful to knowing how your cat is doing so keep at it!
 
It's fine posting on health forum rather than lantus. Lantus forum is very numbers driven and looks at your ss continuously. So, in the beginning, this is a great place to get lots of help from all.

Others will direct lantus people here, so no worries.

Now as far as where you are getting blood. The majority of us get blood from the ears and there are others who get it from the paw pads. Nobody gets blood from the neck or jugular vein. So, far I've seen another vet test this way and I was horrified when told about it. I quickly showed the person how to test the ears and after a few attempts it worked. This particular cat happened to have one ear that bled better than the other.

Here are some pics to help you understand where on the ear to poke. Anywhere along the edge between the vein and edge is fine.

sweetspot.jpg


What size lancets are you using? The lower the number the thicker the needle, I suggest starting at 30 or 31 gauge.

Do you need help with your technique of poking? If you are free hand poking, I suggest holding it an an upward 45 degree angle and poking that way.

101_0669.jpg
 
You are actually starting to get some good numbers on one unit. One recommendation I have is not to change doses so frequently. You have to give each dose at least a week to allow the body to adjust to it before you can determine if you need to raise it. The only exception is if you start seeing hypo numbers too early in your curve. I suggest that you stick with the 1 unit for at least a week before making any changes and if you do increase, only do it by 1/4 unit. Again, you need to keep at the new dose for at least one week.

Also, what are you feeding her? That will also contribute to the high numbers you are seeing.

Also, are you using the lancet device or freehand? Many of us find it easier to freehand instead of using the device
 
Hi --

Do read all the "sticky" posts at the top of the Lantus group -- and especially the one about becoming "DATA READY TO SHOOT LOWER NUMBERS?"

As your dose is getting close to "just right" for your kitty, you will need to start shooting lower numbers than you are currently comfortable with.

I use Levemir for my two adopted diabetic cats. They are both well regulated (normal range >99% of the time) on a tiny dose and only eat low carb canned food.

I haven't updated my online spreadsheets in a long time, but after testing at least twice per day for months, we are comfortable injecting insuliln with preshot BGs as low as 75 (knowing from the history, that they are going up and it is safe to shoot). The only time my cats are over 150 is if they get into some people food or steal some from my underweight kitties that I'm trying to give extra food - higher calorie / higher carb.

So --when you have been skipping shots, your kitty's "shed" is running out. Even giving a half dose is better than totally skipping a shot.

Try getting a blood sample from the paw pad. ALSO.... if the kitty is dehydrated, it is harder to get enough blood -- try adding some water to the canned food to make is soupier, and see if this helps with getting blood.
 
I did read that. I suppose it's different to do that sort of thing on your own and with the support of the group. Now that I'm here I'll definitely try it. Hopefully that's going to be the key.
 
What size lancets are you using? The lower the number the thicker the needle, I suggest starting at 30 or 31 gauge.
Click to expand...

I don't know exactly what they are--they're for a pen--but they are definitely bigger than that. My home vet gave me some free-hand lancets, but they're much bigger than that as well. I'm not exactly known for my steady hand, so the larger hand-held lancet was a little over-the-top when successful--a gentle prick brought nothing, while a more forceful prick brought the floods. Maybe I do need to switch to free-hand. I have 30 guage needles, do you think I could try it with that? A clean one, of course.
 
I wouldn't use the needle to poke. Because it is a longer needle than the lancet and while you can pierce with the lancet, it's short enough that it won't be a big deal, but with a needle, it's much longer and I'd just be concerned about not having a good feel for it and piercing too much.

Go to the pharmacy and pick up a box of lancets, they're inexpensive and you can see the pic on the box to get an idea of the size. If you need the length to hold onto, you can use the lancet device that came with your meter, keep the top off and just use it as an extended lancet and not actually engage the device.
 
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