New to Board - Would love some guidance!

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MrW

Member Since 2012
Hi everyone...My name is Lorin and my kitty is Mr. Wendall. He is 19 years young. He was diagnosed in June and I have been lurking around for the past couple of months. He is currently on lantus - 1 unit twice daily. I would LOVE help in getting him regulated and hopefully otj!! I live on a small island on the east coast and have found it quite challenging to find vet care for his condition. I am so grateful to have found this board. It's amazing the tremendous amount of love and support available here!

About a week after Mr. W was diagnosed with diabetes he lost the ability to walk on his own. He saw a specialist at Angell Memorial in Boston and it was determined it was not diabetic neuropathy. They're not quite sure what - though FCE was thrown out. Because of his age we decided not to do an mri. I used to live in Los Angeles and in researching found a really great rehabilitation clinic in Santa Monica. We arrived in SM last Monday, started therapy on Tuesday and have already seen improvement! I am hoping to be here for a month and get him walking again. I had hoped to utilize the resources of a more experienced vet here to support me with his diabetes - if anyone has recommendations for someone in the Santa Monica/LA area I am open to suggestions! Though more and more I am realizing that I am going to have to take control of his regulation.

I would love some eyes on his numbers and guidance on how to proceed.

I'm so glad to be here and am relieved to know I am not alone!
 
Welcome! How wonderful that you found help in Santa Monica. We have lots of members in Californa. Perhaps if you put Santa Monica in your subject line, it might catch their eye.
 
Hi Lorin and Mr. Wendall,
Welcome to FDMB. I also live on a small island on the east coast :smile:
I have never used your insulin, just read about it a bunch. The first thing that strikes me when looking at your spreadsheet is the different doses. I can see that you were advised to drop down to .5 due to having to skip many shots, but you elected to go with .75 instead. That's actually a good move, because in most cases, adjustments are advised in .25 increments. That said, one thing I do understand about Lantus is that it works best with a consistent dose. It can take 3-5 days for a dose to "settle" so that you can see what it really will do. Whether that is 1u, .75u or .5u, if you could stick with one dose I think you would see better results. Lantus dosing is based on the reading that you would get at nadir, and it does look like you've gotten a good number of tests in the area of +6 hours after the shot. That, as I understand it, is the number you are after so that the curves make more sense.

I'm going to go to the Lantus Tight Regulation forum, which is our busiest forum on the board, and ask for some folks with lots of Lantus experience to take a look at this thread and Wendall's spreadsheet, so hopefully you'll get some more input soon...

Carl
 
Hi, Loren and welcome to FDMB.

My first suggestion, if you've not already done so, is to read the starred sticky notes at the top of the Lantus Board. I've summarized their content and provided links to each of the notes.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Lantus & Levemir: Shooting & Handling Low Numbers: What data you need in order to be able to work toward remission or tight regulation as well as information if you have a low pre-shot number or a drop into low numbers during the cycle.
One of the things that makes Lantus work best is consistency. Shots need to be given as close to every 12 hours as possible. I noticed that you have given some late shots. When you shoot late, your next shot is 12 hours from the time you actually shot. When you shoot late, it acts like a dose reduction. An early shot acts like a dose increase. This is why consistency is important. If you change your shot time, you can generally move the time either by 15 min. at each shot time or bye 30 min. once a day.

Doses need time to settle before they are changed. Typically, you administer the same amount of insulin at AM and PM shot times and you hold each dose for 3 days (6 cycles). Lantus is a depot-type of drug and as such, there isn't an immediate response to a dose change. Rather, doses are cumulative and there is overlap between doses. This is, in part, what gives Lantus its duration. In looking at your spreadsheet, it looks like when you've made rapid changes in dose, Mr. Wendell's numbers become wonky. What I would encourage you to do is to stick with a dose (e.g., either 0.75u or 1.0u) for 3 days. Once you see how that dose is working, you can increase. However if Mr. Wendell's numbers drop below 50, it indicates that the dose needs to be reduced by 0.25u.
 
Re: New to Board - Would love some guidance-Santa Monica

Thanks so much for the replies!!! Very helpful info. I will try to stick with consistent dosing for twice a day for at least three days and see how it goes. A bit overwhelmed at the moment. I came down with a nasty cold a few days a go. And lo and behold, Mr. Wendall now has an upper respiratory infection. He's very congested, but hopefully I caught it early. He hasn't had one since he was a kitten. :sad: I had to take him to the er yesterday and missed his am shot. Luckily, when I checked his glucose a few hours after the shot was due it was below 200 so I skipped it.

This is a question I have - if I do have to shoot late due to unforeseen circumstances, should I shoot a reduced dose based on the glucose number at the time, or just skip it? Also, if missing a dose at the scheduled time due to low number etc., up to how many hours after the dose was due could I shoot before I should just skip? I hope this isn't too confusing?
 
Hi Lorin and Mr. Wendall,

Welcome to the community. I'm new here too, and so far this community has seriously stopped me from becoming a crazy, stressed out kitty momma. I say kitty, but my Charlie is not so young either. It sounds like you're very committed to doing whatever you can to help Mr Wendall (that name just makes me smile every time I read/write it). :lol:

Just wanted to wish you good luck and a warm welcome from Charlie and I.

Charlie is currently hiding behind the couch and feeling pretty crappy. You will have good and bad days but hopefully the bad ones can be made at least a tiny bit better from the coaching and warmth you'll find here.

Best of luck to you guys.
 
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