New to board- Looking for thoughts- Numbers included

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Jason & Belle (GA)

Jason & Belle (GA)

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Hi folks,

My 12.5 year old cat has what we believe is steroid induced diabetes. Her initial numbers pre insulin were in the high 300's. She was started on Lantus about 3 weeks ago at 2 units twice a day. At a week and a half, she had her first Glucose curve
and she was fairly steady but never got below 265. The vet recommended increasing to 3 units twice daily. We did so and in the next few days, she was tested sporadically and was anywhere from 300 at +8 to 390 +8. It certainly did not seem like the increase had and effect. I was traveling and she didn't get tested all week, and when I came home yesterday I tested her through the PM shot. She gets her shot at 9am/9pm and here are the numbers I've seen:

4/16
+8 = 88
+9 = 102
PMPS = 97

The vet was not available but the vet tech said ignore the levels and give the shot. These numbers were very low compared to what I'd seen previously, so I ignored her and didn't give the shot. So after not giving her the shot, I awoke this morning to:

4/17
AMPS = 152

Since I planned on being around all day, I did give her the shot and have been checking it every two hours. This Is what I've seen so far:

+2 = 157
+4 = 166

I have no idea how to interpret this and I did speak to the vet today and she said to reduce the dose to 1 unit twice a day. Since I don't know when her number improved and where her pre shot numbers were in the days before I came home, is it possible that she was regulated on the 3 units twice a day to the point where her numbers were that consistently low? Her numbers did not increase that much with the missed dose, and they haven't decreased at all after this mornings dose. I'm just confused as to whether 3 was the right place to be, or if I should reduce the dose as the doctor recommended.

I'm thrilled that a forum like this exists, especially since the vet is never available right when you need them. Thanks in advance for any assistance you can offer.

Jason
 
Welcome to LL Jason!!

Someone will be in shortly to direct you to all the right places to read.. so you can make your brain explode ;)..

GREAT to hear you are hometesting.. and awesome that you went with your gutt and ignored their advice last night.. shooting 3U last night (based on those numbers) could have been bad news...

I have to take off for a little while.. but just wanted to say real quick.. keep testing.. I'm pretty sure that it will be recommended that you go to a lower dose than 3U!.. but you'll want to test a bunch through the PM cycle as well (Lantus can have a pretty long lasting effect, into the next cycle, people will explain more shortly :) ).. so I recommend at least trying to get a nap somewhere in today.. unless you are quite responsive to caffeine ;)

Follow these peoples advice to a T.. they are smart cookies.
 
I do think it's possible that 3 units is a good dose for her, or at least not very far off. However, even if that is true, I would suspect that she may be about to go into a phase where she'll need some dose reductions. Often those can come really fast, especially in a steroid-induced diabetic (they can heal quickly once they make up their minds to do so). I'm afraid that reducing all the way to 1 unit all at once might stall her progress. Without more data, it's hard to say for sure.

It would be really great if you can set up a spreadsheet and post here every day, so we can help keep an eye on her trends. Can you make a commitment to test at least at every preshot, and at least one additional spot check per day? (more is better, we're dataholics here, but it helps us help you). If she does need a dose reduction, we need to catch it quickly because you didn't work up to this dose in our traditional way, so we can't be 100% sure that it is a safe dose to work from.

What is her diet? (and what is her name?) :smile:

Today's cycle is probably flat because of the missed shot yesterday. It can take a while for the "shed" to refill (read the stickies on this forum for more information). Tonight and tomorrow morning will be more telling.

Welcome to Lantus Land!
 
Thanks for the replies!

Her name is Belle, and I've had her since she was 5 weeks old. She is the most amazing cat, but has a bunch of health problems including:

IBD
Kidney/Bladder Stones
Hyperthyroidism(treated)
Cardiomyopathy(probably from the Hyperthyroidism)
Infectious Anemia
Recently torn Cruciate ligament
Asthma

I've tried to change her diet numerous times due to the IBD, but she is not at all amenable. When she was first diagnosed with Diabetes, I bought Blue Buffalo Wilderness cans and she devoured them, but after two weeks, she has refused to touch it. This, unfortunately, is typical. I have been through every food imaginable, and it's always the same. She will only eats dry, and even then, she is still very picky. I have tried every brand imaginable here too. Right now she is eating Iams Low Residue Dry(I know this is very high in carbs and low quality but it helped her IBD quite a bit) and Blue Buffalo Chicken and Rice. I don't think a change of diet is in the cards.

As for testing, I will be doing both preshot tests, and if possible, fixed intervals through out the day. I travel quite a bit though, and my wife won't do the tests. I will definitely be monitoring much more closely the next few days. Since I gave her the 3 units this morning, my vet recommended I skip tonight, so this is the first thing I need to decide on. I guess the remainder of todays monitoring will give me some idea of what to do.

Thanks again,

Jason
 
Libby is very experienced and her questions are on target. If your cat is getting dry food, even if it is relatively low carb, that is likely influencing the BG numbers that you are seeing. Many of the canned foods are also quite high in carbs. Diabetics do far better on a low carb diet. We've seen a number of cat's whose levels have dropped significantly with food changes whether they were steroid induced or not. Please let us know if we can give you a hand with food recommendations. There are some great resources available. (Our posts crossed.) However, have you thought of trying to feed a raw diet? It is supposed to be good for IBD problems. If you've not seen it, check out the site by Lisa Pierson, DVM on feline nutrition[/b].

I'm not sure that I agree with the advice that the vet tech provided you. While Lantus dosing is based on the low point of the cycle (nadir), we look at pre-shot values in order to determine whether it's safe to give a shot. Since there is usually someone with experience on the Board close to 24/7, if you get a lower than expected pre-shot number, please post and we can help you look at your options and insuring that your cat is safe.

You're doing a great job getting a curve. If you can also get in at least one PM spot check, like Libby suggested, that will be very helpful. Many cats have lower numbers at night so having a sense of what is happening then is important. Likewise, if you are up and about before your cat's shot time (e.g., at PM +10 or +11), that information is extremely useful.
 
Thanks for the feedback. I never considered a raw diet, but I may look into it. Since I travel quite a bit and my wife has a varying schedule, it would be hard to have on one exclusively, but I would love to find something that she would eat at shot time, and would significantly decrease her dry food intake. We have 8 cats, so we do free feed dry, but they all do get some wet throughout the day.

I will try and test her sometime during the night, especially now that her levels have dropped significantly since she was diagnosed. I'm petrified that she will have a hypoglycemic episode while I'm sleeping, and with all of her other problems, may not make it through the night. For this reason alone, we check her numerous times throughout the night. We'll just add a test here and there.

I also added the spreadsheet to my signature, and will update it as necessary.

Jason

http://spreadsheets.google.com/pub?key= ... utput=html
 
She'll be fine.. I have experience with a decent part of Belle's long health list.. so I have a pretty good idea how well take great care of her (and the rest of your huge furry family I'm guessing!!).. if you are monitoring and following the protocol here.. it's actually really unlikely that your cat will hypo.. next little bit might be a little crazy because obviously Belle has been on the move and nobody is really sure what she's doing.. but you'll test a bunch.. and get a feel for how she reacts and things will get a lot easier in that regard..

Read the stickies.. multiple times (it's a lot to let sink in, hehe).. and ask lots of questions.. great job getting your spreadsheet up..

The raw food is a really good suggestion.. certainly something you should look in to.. my understand is that it's actually a much cheaper way to feed a large family too!
 
Ok, the last 3 results:

+6 = 175
+8.5 = 133
+10.5 = 163

Next will be her PMPS.

As I mentioned earlier, the Vet recommended that I not give her a shot tonight because I gave her the full 3 units this morning, then go to 1 unit twice a day starting tomorrow morning. However, after skipping last nights dose, we haven't approached sub 100 numbers today. I would think she still needs some insulin tonight. The question is, how much? I know nobody can tell me specifically what to do here, but your past experiences may help me make a decision.

Thanks again,

Jason
 
I personally don't think the advice your vet gave this go around was that bad.. I think their thinking is to empty out the shed.. and start fresh in the AM.. however.. with how actively you are home testing.. you can be more aggressive..

It really depends on your comfort level at this point.. Libby has a really good eye for doses.. so whatever she thinks your cats right dose is, there's a pretty decent chance that's it ;).. but with your schedule of traveling and all.. and your wife not being willing to test (is there any hope of talking her into it?? :) ).. you may not want to hit the "perfect" dose right off the bat..

The more aggressive you are, the more likely your cat is to go into remission.. and that is generally considered the second most important goal (first being make your cat healthy and safe).. just a matter of whether or not you will have a heart attack along the way ;)..

I see you shot 1U.. I don't think that was a bad choice.. you need to be comfortable since the responsibility lies ultimately on you.. the important thing at this point is to decide how aggressive you want to be.. and stick with it.. Lantus works best with consistent dosing.. so you need to find something you can shoot the same amount of, every cycle..

I think.. you know.. in the like half a day I've known you through a forum ;).. I think you can handle being a bit more aggressive than starting over at 1.. consider tonight a BCS (a big chicken s*** dose.. that we do when numbers are lower than we are comfortable shooting a full dose at.. just to get something into the shed so things don't go so out of wack).. and go up some in the morning and stick with it.. (takes around 3 days or so for a dose to settle in)..

2U maybe? I'm not sure.. would really like one of the more experienced people to chime in here.. and if you could give some idea what sort of testing your schedule will allow over the next week or two.. and if your wife can be coaxed over to the test-a-holic side ;).. that would be really helpful.
 
sorry I didn't see your post before you shot.

Honestly, based on the 2 days of numbers we have, 3 units is looking really good. If she were going too low, we would most likely be seeing some big bounces. If you're wanting to reduce because of the 97 at PS time last night (which is a nice number, but it's understandable that you wouldn't be comfortable shooting that the first time you see it, without data to back up the decision), then the normal reduction would be to 2.75. I don't see anything screaming "Danger, danger!" that would make me want to back off any further than that. A lot of times we DO have cats that come in here on 3 unit doses and the spreadsheets make me scared, but this one makes me go "ahhhhh, nice."

Of course it's ultimately your decision, Belle is your cat and you're the one holding the syringe. :smile: That's just my opinion, based on my experience here.
 
What a beautiful cycle today for Belle!

The only thought that I would have is to ask a question about your weekday schedule. You mention that you travel a great deal and that your wife isn't comfortable testing. Are you going to be able to test at shot time or will your wife be giving shots?

I also noticed that the link to the site I gave you wasn't active. This link to feline nutrition should work. There are also commercially prepared raw foods that are shipped frozen, like Feline's Pride.
 
just wanted to stop by to say hello and welcome to lantus land!
you're collecting a lot of valuable data which will go a long way in determining dose.
hope to see you posting often...
 
Listen to Libby.. she's smart ;) Green and Blue numbers are very pretty.. it just takes some time to get used to them.. because a lot of information online, from vets, and even on this site suggest a pretty non-aggressive approach.. because the average pet parent isn't usually (sadly) very on the ball with testing, keeping an eye on their cat, learning how to understand how insulin works in their cat.. etc..

At one point I told Libby and others that I thought they were crazy with their advice they gave me.. (I had some of the "rules" pretty ingrained in my brain ;) ).. this morning Nova was 74 at PS.. and I didn't even blink giving her shot because I've learned how she reacts.. until you have that 'eye'.. borrow someone else's ;).

Oh also.. if you look how other peoples thread titles are formatted.. get a handle on that.. and when you are looking for advice or having problems.. add "dose?" or "help!", "problem", "question" etc to the end.. it catches people's attention a lot better.. helps people notice things that need addressing vs updates in threads from random chit chat..

New thread each day.. that we refer to as a "condo"..
 
I appreciate the input from everyone. It's scary to be doing something so new and important without guidance. Personally, I agree that 3 units seems to be about right, but even though her numbers were higher tonight, I'm afraid to take a chance when I can't watch her every second. If this was the AM, I probably would have gone with at least 2.5U. I really wish I new when the low numbers started because she was getting 3U all week, and it's possible she was just very well regulated on that dose. It's a hard position to be in because if I go against the Vets recommendations, then it makes it difficult to ask for her advice, and she does treat Belle for a number of other things. In the end, I'll just go with my gut. I'm not traveling this week, so I'll be able to keep a close eye on her and try to get things settled.

I don't know how frequently I'll post, but I will use the suggested format in the future and I will continue to update the spreadsheet.

Again, I appreciate all the help and am sure it will prove invaluable moving forward.

Jason








Dawn & Nova said:
Listen to Libby.. she's smart ;) Green and Blue numbers are very pretty.. it just takes some time to get used to them.. because a lot of information online, from vets, and even on this site suggest a pretty non-aggressive approach.. because the average pet parent isn't usually (sadly) very on the ball with testing, keeping an eye on their cat, learning how to understand how insulin works in their cat.. etc..

At one point I told Libby and others that I thought they were crazy with their advice they gave me.. (I had some of the "rules" pretty ingrained in my brain ;) ).. this morning Nova was 74 at PS.. and I didn't even blink giving her shot because I've learned how she reacts.. until you have that 'eye'.. borrow someone else's ;).

Oh also.. if you look how other peoples thread titles are formatted.. get a handle on that.. and when you are looking for advice or having problems.. add "dose?" or "help!", "problem", "question" etc to the end.. it catches people's attention a lot better.. helps people notice things that need addressing vs updates in threads from random chit chat..

New thread each day.. that we refer to as a "condo"..
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